Document 6421865

TRANSACTIONS
AMERICAN
LARYNGOLOGICAL ASSOCIATION
2011
VOLUME ONE HUNDRED THIRTY-FIRST
“DOCENDO DISCIMUS”
ONE HUNDRED THIRTY-SECOND ANNUAL MEETING
SHERATON CHICAGO HOTEL AND TOWER
CHICAGO, ILLINOIS
APRIL 27-28, 2011
PUBLISHED BY THE ASSOCIATION
NASHVILLE, TENNESSEE
MARK S. COUREY, MD, EDITOR
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TABLE OF CONTENTS
Annual Photograph …….………………………………………...……………………………….…...9
Post-Graduate Members.......................................................................................................................10
Officers 2010-2011….……………………………………..……….…...…………………………...…11
Officers 2011-2012.………………………….................................................…………….……..….…11
Registration of Fellows..........................................................................................................................12
Minutes of the Executive Sessions.……………………………….................……...………………..13
Reports
Secretary, C. Gaelyn Garrett, MD …..............................................................................................13
Treasurer, Michael S. Benninger, MD.….……….........………….………….…….............…..…13
Editor, Mark S. Courey, MD..………….……………………………......……...............................14
Historian, Robert H. Ossoff, DMD, MD……………………………...………………………….14
Recipients of De Roaldes, Casselberry, and Newcomb Awards .................……..……………....15
Recipients of Gabriel F. Tucker, American Laryngological Association,
Resident Research, and Young Faculty Research Awards…………………...….…................16
The Memorial and Laryngological Research Funds…....………………..………………...….18
Presidential Address
Andrew Blitzer, MD, DDS..............................…..….....................................…………………....19
Presidential Citations
Charles N. Ford, MD; Marvin P. Fried, MD; Allen D. Hillel, MD;
Gayle E. Woodson, MD; Eiji Yanagisawa, MD; Steven E. Zeitels, MD…..............................22
Introduction of Guests of Honor, Marshall Strome, MD
Andrew Blitzer, MD, DDS….…..……………………………………….………….…………....28
Presentation of the American Laryngological Association Award to
Lawrence W. DeSanto, MD
Presented by Ricard Hayden, MD..................................................…………........................... 30
Presentation of the Gabriel F. Tucker Award to Mark Richardson, MD
Presented by Ellen Friedman, MD.......................................................................................32
Introduction of State of the Art Lecture, Kristina Simonyan, MD, PhD
Presented by Andrew Blitzer, MD, FACS...............…………………....……………………. 34
State of the Art Lecture: Functional MRI and Understanding the Neural
Control of the Larynx
Kristina Simonyan, MD, PhD.......................................................................................................35
Introduction of State of the Art Lecture, Steve M. Zeitels, MD, FACS
Presented by Andrew Blitzer, MD, FACS...............……………………....……………..…... 39
State of the Art Lecture
Steven M. Zeitels, MD, FACS......................................................................................................40
Introduction of the Thirty-Seventh Daniel C. Baker, Jr. Memorial Lecturer,
Andrew Blitzer, MD, DDS ...….….........….................................................................................45
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Table of Contents
Daniel C. Baker, Jr., Memorial Lecture: “The Animal Spirits: A Curse of the
Vagus Nerve”
Clarence T. Sasaki, MD ..………....…………..………………...…...…………….……..…............46
SCIENTIFIC SESSIONS
The Effect of Temporary Vocal Fold Injection Medialization Laryngoplasty on the Rate of
Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis Patients
Katherine C. Yung, MD; Ilya Likhterov, MD; Mark S. Courey, MD……………………………52
Synkinetic Reinnervation and Restores Function
David L. Zealear, PhD; Kenichiro Nomura, MD, PhD; Isamu Kunibe, MD, PhD;
Akihiro Katada, MD, PhD; Yike Li, MD; Rajshri Mainthia, BS;
Cheryl Billante, PhD……………………………………………………………………………...52
A Cost Analysis of True Vocal Fold Paralysis Secondary to Thyroidectomy
Philip Weissbrod, MD; Michael Pitman, MD…………………...……………………………….53
Qualitative and Quantitative Laryngeal Electromyography Predicts Motion Recovery in
Acute Recurrent Laryngeal Neuropathy
Libby J. Smith, DO; Clark A. Rosen, MD; Christian Niyonkuru;
Michael C. Munin, MD ………………………………………………………………..…………53
Laryngeal Electromyography for Prognosis of Vocal Fold Palsy: A Meta-Analysis
Scott Rickert, MD; Lesley Childs, MD; Tom Murry, PhD; Lucian Sulica, MD …………...……54
Total Resection of the Cricoid Cartilage with Thyrotracheal Anastomosis in the
Treatment of Low-Grade Chondrosarcoma of the Larynx.
Andrea Gallo, MD, PhD; Marco de Vincentiis, MD; Antonio Greco, MD;
Massimo Fusconi, MD; Giulio Pagliuca, MD, PhD; Salvatore Martellucci, MD, PhD………….54
CT-Scan Prediction of Thyroid Cartilage Invasion for Early Laryngeal Squamous
Cell Carcinoma
Dana M. Hartl, MD, PhD; Guillaume Landry, MD; Francois Bidault, MD;
Morbize Julieron, MD; Gérard Mamelle, MD; Francois Janot, MD;
Daniel F. Brasnu, MD…………………………………………………………………………….55
Thyroid Cartilage Invasion in Early-Stage Squamous Cell Carcinoma Involving the Anterior
Commissure
Dana Hartl, MD, PhD; Guillaume Landry, MD; Odile Casiraghi, MD;
Patrick Marandas, MD; Francois Janot, MD; Stéphane Hans, MD, PhD;
Daniel F. Brasnu, MD ...…………..………………………………….……….…………….… 55
Salvage Surgery for Laryngeal Cancer after Failure of Different Organ Preservation Strategies
Cesare Piazza, MD; Giorgio Peretti, MD; Francesca Del Bon, MD
Stefano Mangili, MD; Luca Oscar Redaelli De Zinis, MD; Piero Nicolai, MD………………...56
Optical Injector: A Novel Device for Improved Airway Injection
Sanjay Manohar Athavale, MD……………………………………………………………...…...56
A Multi-Institutional Analysis of Tracheotomy Complications
Stacey Halum, MD; Gregory Postma, MD; Nicole Maronian, MD;
John Sinacori, MD; Michael Pitman, MD; Sid Khosla, MD;
Dale Ekbom, MD; Albert Merati, MD……………………………………………………………57
Partial Posterior Cricoid Plate Removal for Wide Interarytenoid Distance
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Nicolas Maragos, MD………………………………………………………………………..…...57
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Table of Contents
Voice Outcomes Following Adult Cricotracheal Resection
Jeffrey J. Houlton, MD; Alessandro de Alarcon, MD; Kalaan Johnson, MD;
Jareen Meinzen-Derr, PhD, MPH; Susan Baker-Brehm, PhD, CCC-SLP;
Barbara Weinrich, PhD, CCC-SLP; Ravindhra G. Elluru, MD, PhD………………………...….58
Raised Intensity Phonation Compromises Vocal Fold Epithelial Barrier Integrity
Bernard Rousseau, PhD, CCC-SLP; Atsushi Suehiro, MD, PhD;
Nicholas Echemendia, BS; Mahalakshmi Sivasankar, PhD……………………………………...58
Regeneration of Aged Vocal Folds with Basic Fibroblast Growth Factor: Results of Clinical Trial
Shigeru Hirano, MD; Ichiro Tateya, MD, PhD; Yo Kishimoto, MD;
Satoshi Ohno, MD; Tsuyoshi Kojima, MD; Shin-ichi Kanemaru, MD………………………….59
Glucocorticoids and the Vocal Fold Mucosa
Ryan C. Branski, PhD; Hang Zhou, MD, MS; Mahalakshmi Sivasankar, PhD;
Milan Amin, MD; Dennis H. Kraus, MD…………………………………………………….......59
Western Blot Confirmation of the H+/K+-Atpase Proton Pump in the Human Larynx and
Submandibular Gland
Kenneth W. Altman, MD, PhD; Yayoi Kinoshita, DMD;
Melin Tan-Geller, MD; David Burstein, MD; James A. Radosevich, PhD………………………60
Sendai Virus-Mediated Transgene Expression in the Larynx
Daisuke Mizokami, MD; Nobuaki Tanaka, MD; Hiroshi Suzuki, MD;
Makoto Inque, PhD; Mamoru Hasegawa, PhD; Akihiro Shoitani, MD;
Koji Araki, MD, PhD……………………………………………………......................................60
Bioengineered Prosthesis with Fibroblasts for Cricoid Regeneration
Yukio Nomoto, MD; Wataru Okano, MD; Mituyoshi Imaizumi, MD;
Akiko Tani, MD; Mika Nomoto, MD; Koichi Omori, MD……………………………………....61
Cervical Variation of the Phrenic Nerve
Adam DeConde, MD; H. Wayne Lambert, PhD; Sean Dodson, BS;
Blake Daney, BA; Elena Stark, MD, PhD; Gerald S. Berke, MD;
Jonathan J. Wisco, PhD; Abie Mendelsohn, MD………………………………………………...61
High-Speed Videoendoscopic Analysis of Relationships between Cepstral-Based Acoustic
Measures and Voice Production Mechanisms in Patients Undergoing Phonomicrosurgery
Daryush D. Mehta, PhD; Steven M. Zeitels, MD; James A. Burns, MD;
Aaron D. Friedman, MD; Dimitar D. Deliyski, PhD;
Robert E. Hillman, PhD; Susan Thibeault, PhD…………………………….……………62
Genetic Characterization of Pre-Malignant and Malignant Vocal Fold Lesions
Rebecca S. Bartlett, MA; W. Wesley Heckman, MD; Jason Isenberg, MD;
Susan Thibeault, PhD; Seth H. Dailey, MD……………………………………………………...62
Laryngeal Dysplasia: Role of Human Papillomavirus in Nonsmokers
Andrea Gallo, MD, PhD; Giulio Pagliuca, MD, PhD; Anna Marta Degener, PhD;
Alessandra Pierangeli, PhD; Salvatore Martellucci, MD; Marco de Vincentiis, MD……………63
Extra-Esophageal Reflux & Surgical Fundoplication: What Parameters Predict Symptomatic
Improvement?
David O. Francis, MD; Marion Goutte, BS; James C. Slaughter, PhD;
C. Gaelyn Garrett, MD; Michael Holzman, MD; Michael F. Vaezi, MD, PhD………………63
Efficacy of Large Diameter Dilatation in Cricopharyngeal Dysfunction
Matthew S. Clary, MD; Scott Keith, MD; Maurits Boon, MD; Joseph R. Spiegel, MD………...64
A Histological Examination of the Quadrangular Membrane
Nwanmegha Young, MD; Clarence T. Sasaki, MD…………………………………………...64
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Table of Contents
A New Method for Assuming Vocal Fold Shear Property with Surface Wave Analysis
Masaru Yamashita, MD, PhD; Hirohito Kobayashi, PhD………………………………………..65
Atypical Laryngeal Manifestations in Oral-Facial-Digital Syndrome, Type I
Robert W. Kopp II, BS; Anthony J. Mortelliti, MD; Joel E. Portnoy, MD………..……………..65
Awake Flexible Fiber CO2 Laser Ablation of Tracheal and Subglottic Stenosis
Michael A. Zozzaro, MD; Erik Cohen, MD; Sanaz Harirchian, MD; Kim Murray, MD……..…66
Bilateral Vocal Cord Paresis related to Vagal Nerve Stimulation
Jonathan M Sherman, MD; Jacqueline P Corey, MD;
Nadieska Caballero, MD; Daniel E Martin, PhD .........…………………………….…..….........66
Complete Laryngeal and Tongue Dysfunction in an Acute LVAD Patient:
An Airway, Feeding, and Voice Dilemma
Yi-Hsuan Emmy Wu, MD; Thomas Carroll, MD……………………………….……………….67
Co-Prevalence of Tremor in Patients with Spasmodic Dysphonia: A Case-Control Study
Laura White, BS; H.A. Jinnah, MD, PhD; John Hanfelt, PhD;
Michael M. Johns II, MD………………………………………………………………………....67
Diagnosis of Chronic Cough Due to Bordatella Pertussis in the Adult Population
Jonathan M. Bock, MD; Michael O. Frank, MD……………………………………...……….....68
Differential Expression of TGF-ß Isoforms 1 and 3 Following Vocal Fold Mucosal Injury
Zhen Chang, PhD; Ayesha Hasan, BS; Yo Kishimoto, MD;
Ayami Kishimoto, MD; Nathan V. Welham, PhD……………………………………………….68
Efficacy of Laryngeal Botulinum Toxin Injection: Comparison of Two Techniques
Susan L. Fulmer, MD; Albert L. Merati, MD; Joel H. Blumin, MD……………......…….……...69
Endoscopic Lysis with Keel Placement for Anterior Glottic Webs.
Randal C. Paniello, MD; Sid M. Khosla,MD ….…………………………………..…………… 69
Evaluation of Dysphonic Patients by General Otolaryngologists
Seth M. Cohen, MD, MPH; Michael Pitman, MD;
J. Pieter Noordzij, MD; Mark S. Courey, MD……………………………………………………70
Explant Culture of Fibroblasts Obtained from Chronically Scarred Rat Vocal Folds
Yo Kishimoto, MD; Ayami Kishimoto, MD; Diane M. Bless, PhD;
Nathan V. Welham, PhD ……………………….……………………………………………… 70
Globus Sensation is Associated with Abnormal Esophageal Bolus Transit
Catherine J. Rees, MD; Kristin K. Marcum, MD; Nicholas Musisca, MS;
Susan G. Butler, PhD…………………………………………………..........................................71
Histopathologic Investigations of the Unphonated Human Vocal Fold Mucosa for a Decade
Kiminori Sato, MD, PhD; Hirohito Umeno, MD; Takeharu Ono, MD;
Tadashi Nakashima, MD………………………………………………………….…………….. 71
Imaging Mass Spectrometry for the Analysis of Vocal Folds
Ichiro Tateya, MD, PhD; Yoshinori Takizawa, MD; Seiji Ishikawa, MD;
Morimasa Kitamura, MD; Mitsutoshi Setou, MD, PhD; Juichi Ito, MD, PhD…………………..72
Impact of Acute Oxidative Stress on Barrier Properties of Vocal Fold Epithelia
Rebecca Alper, MD; Elizabeth Erickson-Levendoski, MS; Sherleen Fu, BS;
Wei Zheng, PhD; Mahalakshmi Sivasankar, MD……………………………..………………….72
Incidence of Distinct Benign Mid-Membranous Vocal Fold Lesions as Classified with a
Novel Paradigm System
Clark A. Rosen, MD; Jackie Gartner-Schmidt, PhD; Robert T. Sataloff, MD, DMA;
Greg Postma, MD; C. Blake Simpson, MD; Mark S. Courey, MD……………………………....73
Intubation Granuloma of the Membranous Vocal Fold
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Scott Rickert, MD; Vikash Modi, MD; Robert Ward, MD; Lucian Sulica, MD…………………73
Table of Contents
Klebsiella Pneumoniae Descending Cervical Necrotizing Fasciitis Originating as a Paraglottic
Abscess
Justin S. Golub, MD; Sandy Mong, MD; Philip A. Weissbrod, MD;
Thomas K. Varghese, MD; Tanya K. Meyer, MD…………………………………….…………74
Laryngeal Hematoma after Strangulation Injury
Jeffrey Cheng, MD; Benjamin D. Malkin, MD; Nancy Jiang, MD…………………………….. 74
Lysis of Interarytenoid Synechia (Type I Posterior Glottic Stenosis): Vocal Fold Mobility and
Airway Results
Tanya K. Meyer, MD; Jeffrey Wolf, MD ..…………………………………………………........75
National Perspective on Tracheotomy Outcomes and Complications Presents Opportunities for
Targeted Improvements
Rahul K. Shah, MD; Brian Nussenbaum, MD; Lina Lander, ScD;
Albert Merati, MD; David W. Roberson, MD……………………………………………….…..75
Neurofibroma of the Vocal Fold in a HIV Patient Not Associated with Neurofibromatosis Type 1
Heather J. Gomes, MD, MPH; Thomas Carroll, MD…………………………………………….76
New Hoarseness in Patients with a History of Laryngeal Radiation
Scott Rickert, MD; Dan Novakovic, MD; Lucian Sulica, MD…………………………………76
Objective Measurement of the Vocal Effort during Medialisation Thyroplasty: A Feasibility Study
Marc Remacle, MD, PhD; Vincent Bachy, MD; Georges Lawson, MD;
Vinciane Lejoly-Devuyst, MSc SLP; Antoine Giovanni, MD, PhD;
Thierry Legou, PhD; Nayla Matar, MD……………………………..…………………………....77
Onset and Offset Phonation Threshold Pressure and Flow in Excised Human Larynges
Ted Mau, MD, PhD; Joseph Muhlestein, BS; Sean Callahan, MD;
Kent T. Weinheimer, BS; Roger W. Chan, PhD …………………………………………….......77
Optimal Concentration of Hepatocyte Growth Factor for Treatment of the Aged Rat Vocal Fold
Atsushi Suehiro, MD, PhD; Harry Wright, MD; Laurence James, MD;
Bernard Rousseau, PhD, CCC-SLP………………………………………………………………78
Oropharyngeal Symptoms Following Suspension Microlaryngoscopy with a Suspension
Versus Fulcrum-Based Laryngoscope Holder
Taryn Davids, MD; Adam Klein, MD; Michael M. Johns II, MD………………………………78
Overcoming Nasal Discomfort - A Novel Method for Office Based Laser Surgery
Sunil P. Verma, MD; Seth H. Dailey, MD……………………………………………………...79
Patient Tolerance of Awake, In-Office Laryngeal Procedures (AIOLP): A Multi-Institutional
Perspective
VyVy N. Young, MD; Libby J. Smith, DO; Lucian Sulica, MD;
Priya Krishna, MD; Clark A. Rosen, MD…………………………………………………….......79
Post-Operative Herpetic Laryngitis: A Rare Entity
VyVy N. Young, MD; Priya Krishna, MD; Clark A. Rosen, MD…………………………….…80
Preliminary, Prospective Investigation of the Utility of Nimodipine for Acute Vocal Fold Paralysis
Clark A. Rosen, MD; Libby O. Smith, DO; Priya Krishna, MD;
VyVy N. Young, MD; Jackie Gartner-Schmidt, PhD; Michael C. Munin, MD .......................... 80
Proposed Classification System for Reporting KTP 532NM/PDL 585NM Laser Treatment
Effects of Vocal Fold Lesions
Pavan S. Mallur, MD; Michael M. Johns II, MD; Milan R. Amin, MD;
Clark A. Rosen, MD……………………………………………………………………………81
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Table of Contents
Prospective Multi-Arm Evaluation of Surgical Treatments for Vocal Fold Scar and Pathologic
Sulcus Vocalis
Nathan V. Welham, PhD; Seong Hee Choi, PhD; Seth H. Dailey, MD;
Charles N. Ford, MD; Jack J. Jiang, MD, PhD; Diane M. Bless, PhD………..……………….....81
Recurrent Non-Granulomatous Supraglottitis: Managing a Difficult and Rare Disease
Levi Ledgerwood, MD; Peter Belafsky, MD, PhD .…..……………………………………….…82
Reducing Injury During Video-assisted Endotracheal Intubation: The "Smart Stylet" Concept
Philip Weissbrod, MD; Albert L. Merati, MD……………………………………………………82
Spasmodic Dysphonia Triggers: A Combined Clinical Experience of Over 300 Patients
Lesley Childs, MD; Scott Rickert, MD; Thomas Murry, PhD;
Andrew Blitzer, MD, DDS; Lucian Sulica, MD…………………………………………………..83
The Effect of Intraoperative Injection Laryngoplasty with Radiesse vs. Medialization
Thyroplasty with Silastic in Patients with Unilateral Vocal Fold Immobility
James Ruda, MD; Michael S. Benninger, MD; Tom Abelson, MD;
Douglas Hicks, MD; Claudio Milstein, PhD………………………………………….…………..83
The Incidence of Dysphagia in the Elderly with Unilateral Vocal Fold Paralysis (UVFP)
Angela Cogburn Paddack, MD; Alissa Collins, BS; Ozlem E. Tulunay-Ugur, MD……….…….84
The Role of NIM Nerve Monitoring System in Thyroidectomy
Sharon Hughes, BS; Naren Venkatesan, MD; Michael P. Underbrink, MD, MBA……………...84
The Utility of Trial Vocal Fold Augmentation Using Saline
Lesley Childs, MD; Scott Rickert, MD; Daniel Novakovic, MPH, MBBS, BSc;
Andrew Blitzer, MD, DDS…………………………………………………….............................85
Toward Improved Understanding of Common Causes and Consequences of Dysphonia in the
General Population
Seth M. Cohen, MD, MPH; Jaewhan Kim, PhD; Nelson Roy, PhD, CCC-SLP, ASHA-F;
Carl Asche, PhD, MBA; Mark S. Courey, MD…………………………………………………...85
Ultrasound Assessment of Vocal Folds: A Correlation Study with Flexible Fiberoptic Laryngoscopy
Jayme R. Dowdall, MD; Deepak Gupta, MD; Arvind Srirajaklidindi, MD;
Randall Amis, MD; Adam Folbe, MD……………………………………………………............86
Use of a Novel Instrument to Determine Oxygen Consumption and Hemoglobin Levels in Human
Thyroarytenoid Muscle Pre and Post Exercis
Cari M. Tellis, PhD, CCC-SLP; Thomas L. Carroll, MD; Michael Fierro
James J. Sciote, DDS, PhD; Clark A. Rosen, MD………………………………………………..86
Ventilatory Technique for Central Airway Obstruction
Michele P. Morrison, MD; Gregory N. Postma, MD…………………………………………….87
Vocal Fold Granulomas: A Series of 114 Granulomas in a Tertiary Care Center
Nadine V. Yammine, MD, MSc; Karen M. Kost, MD;
Francoise P. Chagnon, MD; Daniel Kost-Stevenson……………………………………………..87
Vocal Fold Vibratory Behavior Changes Following Surgical Treatment of Polyps Investigated with
High-Speed Video Endoscopy and Phonovibrography
Melda Kunduk, MD; Michael Döllinger, PhD; Joerg Lohscheller;
Andrew J. McWhorter, MD……………………………………………………............................88
Memorials
Haskins Kazunori Kashima, MD.....................................................................................................89
Frank Nicholas Ritter, BS, MD, MS, FACS……………..………………………………………..90
Joyce A. Schild, MD………………………………………………………………………………91
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Table of Contents
Officers 1879-2011 .............................................................................................................................92
Deceased Fellows …………………………………………………………………..........................95
Roster of Fellows 2011………………………………………………………………......................100
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OFFICERS 2010-2011
OFFICERS 2011-2012
President……................…Andrew Blitzer, MD, DDS
New York, New York
President…........…....… Michael S. Benninger, MD
Cleveland, Ohio
Vice President/
President-Elect…................ Clarence T. Sasaki, MD
New Haven, Connecticut
Vice President/
President-Elect……........ Clarence T. Sasaki, MD
New Haven, Connecticut
Secretary……..…………...… C. Gaelyn Garrett, MD
Nashville, Tennessee
Secretary……..…………...… C. Gaelyn Garrett, MD
Nashville, Tennessee
Treasurer…………..…… Michael S. Benninger, MD
Cleveland, Ohio
Treasurer…………..……Kenneth Altman, MD, PhD
New York, New York
Editor………..…...…………… Mark S. Courey, MD
San Francisco, California
Historian……………....Robert H. Ossoff, DMD, MD
Nashville, Tennessee
First Councilor….............. Marshall Strome, MD, MS
New York, New York
Second Councilor...… Roger L. Crumley, MD, MBA
Irvine, California
Third Councilor......................... Marvin P. Fried, MD
Bronx, New York
Councilor-at-Large…...... Kenneth Altman, MD, PhD
New York, New York
Councilor-at-Large…………..........Gady Har-El, MD
Hollis, New York
Editor……….…..……..…...… Mark S. Courey, MD
San Francisco, California
Historian….……….......Robert H. Ossoff, DMD, MD
Nashville, Tennessee
First Councilor..............Roger L. Crumley, MD MBA
Irvine, California
Second Councilor.......................Marvin P. Fried, MD
Bronx, New York
Third Councilor................ Andrew Blitzer, MD, DDS
New York, New York
Councilor-at-Large……..................Gady Har-El, MD
Hollis, New York
Councilor-at-Large………......C. Blake Simpson, MD
San Antonio, Texas
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REGISTRATION OF FELLOWS
Active
ABEMAYOR, Elliot
ALTMAN, Kenneth
BAREDES, Soly
BENNINGER, Michael
BERKE, Gerald
BIELAMOWICZ, Steven
BLITZER, Andrew
BURNS, James
CALDARELLI, David
CASTELLANOS, Paul
CHHETRI, Dinesh
COTTON, Robin
COUREY, Mark
CRUMLEY, Roger
CUMMINGS, Charles
DAILEY, Seth
DONOVAN, Donald
EISELE, David
FLINT, Paul
FRANCO, Ramon
FRIED, Marvin P.
FRIEDMAN, Ellen
GARRETT, C. Gaelyn
GOURIN, Christine
GULLANE, Patrick
HAR-EL, Gady
HAYDEN, Richard
HEALY, Gerald
HILLEL, Allen
HOFFMAN, Henry
HOLINGER, Lauren
JAHN, Anthony
JOHNSON, Jonas
KENNEDY, Thomas
KERSCHNER, Joseph
KOMISAR, Arnold
KOST, Karen
KOUFMAN, Jamie
KRAUS, Dennis
LAVERTU, Pierre
LUSK, Rodney
MARAGOS, Nicholas
MATHOG, Robert
MCGILL, Trevor
Emeritus
METSON, Ralph
MIRZA, Natasha
MORRISON, Murray
MYERS, Eugene
NETTERVILLE, James
O’MALLEY, Bert
OSSOFF, Robert
PANIELLO, Randy
PERSKY, Mark
PILLSBURY, Harold
RAHBAR, Reza
RICE, Dale
RICHTSMEIER, William
ROBBINS, K. Thomas
ROSEN, Clark
SASAKI, Clarence
SATALOFF, Robert
SCHAEFER, Steven
SCHULLER, David
SIMPSON, C. Blake
STROME, Marshall
SULICA, Lucian
THOMPSON, Dana
VARVARES, Mark
WEINSTEIN, Gregory
WEISMAN, Robert
WEISSLER, Mark
WENIG, Barry
WOO, Peak
WOODSON, Gayle
YANGAISAWA, Eiji
ZEITELS, Steven
Corresponding
ABITBOL, Jean
BRASNU, Daniel
HIRANO, Shigeru
MAUNE, Steffen
OMORI, Koichi
REMACLE, Marc
SATO, Kiminori
SHIOTANI, Akihiro
YAMASHITA, Masaru
DESANTO, Lawrence
GOLDSTEIN, Jerome
NEEL, Jr., H. Bryan
Associate
CLEVELAND, Thomas
HILLMAN, Robret
MURRY, Thomas
Post-Graduate
ABAZA, Mona
AKST, Lee
ALEXANDER, Ronda
AMIN, Milan
BENSON, Brian
BLUMIN, Joel
BOCK, Jonathan,
BRANSKI, Ryan
BUCKMIRE, Robert
CARROLL, Thomas
CHANDRAN, Swapna
CHANG, Jaime
COHEN, Seth
DEALARCON, Alesandro
EKBOM, Dale
ELLER, Robert
HALUM, Stacey
JOHNS, Michael
KHOSLA, Sid
KLEIN, Adam
MAU, I-Fan Theodore
MEYER, Tanya
PITMAN, Michael
REES, Catherine
RUBIN, Adam
SILVERMAN, Damon
SMITH, Libby
STATHAN, Melissa
VINSON, Kimberly
WRIGHT, Carter
YOUNG, Nwanmegha
YUNG, Katherine
13
MINUTES OF THE EXECUTIVE SESSIONS
REPORT OF THE SECRETARY
The membership prior to the April 2011 election
included 139 Active members, 68 Emeriti members,
49 Corresponding members, 5 Honorary members,
and 5 Associate members, for a total membership of
259 Fellows.
Drs. James Burns, Dinesh Chhetri, Seth Dailey,
Ramon Franco, Chritsine Gourin, Karen Kost, and
Pierre Lavertu were elected to Active Fellowship; Dr.
Akihiro Shiotani was elected to Corresponding
Fellowship and Drs. Herbert Dedo and W. Frederick
McGuirt were elected to Emeritus status.
After election of the nominees, the 2011 roster
reflects 145 Active members, 64 Emeriti members, 47
Corresponding members, 6 Honorary members, and 4
Associate members, for a total membership of 267
Fellows. A new category for Corresponding Emeritus
Fellows was created by the membership las year and
Drs. Benjamin Bruce and Patrick J. Bradley were
elevated to this category.
These totals also reflect we were notified that
four members are deceased prior to this report.
the number of excellent young laryngologists who are
current Post-Graduate Members and once compcleting
their TRIO thesis will be eligible for nomination as
active fellows.
This year, six Post-Graduate Members were
approved for membership. They are Drs. Swapna
Chandran, Joanna D’Elia, Dale Ekbom, Reene Gupta,
Daniel Novakovic, and Sunil Verma.
Dr. Garrett also reported that in 2012, the Head
and Neck Society will not meet during COSM in San
Diego and that in 2013, ASPO will not hold its
meeting in Orlando. However, there are plans to have
a combined session with the ABEA and the European
Laryngology Society (ELS). This will allow more our
the European colleagues to participate in the meeting
and provide an opportunity for collaboration. She
stated that the COSM SLC have agreed to return to
Las Vegas in 2014 where the 2010 meeting was
deemed a success based on the increased number of
attendees. ACS is working on finalizing contract
negotiations with Caesar’s Palace which will be a
more upscale venue.
Dr. Garrett reported that according to the ByLaws, there is a 150 limit for active fellows.
Discussions have taken place to determine if the
Council will recommend an increase to accommodate
Respectfully submitted,
C. Gaelyn Garrett, MD
Secretary
REPORT OF THE TREASURER
The Treasurer’s report and financial statements
were prepared by the ACS. The Treasurer stated that the
relationship with the ACS continues to be successful.
The Council reduced expenses by scheduling the
Winter Council Meeting during the TRIO Sectional
meetings.
Dr. Benninger reported that the finances of the
Association have improved when complared to the
dismal period of 2008-2010 when collectively, $185K
was lost. Additional revenues from publicaitons, i.e.,
Laryngoscope, have increased by $7500. The major
source of continuing income is members’ dues. Although
the amount of outstanding delinquent dues is still high,
there has been an improvement on remittances due in
part to the efforts of our Administrator. Assets have
improved due to a combination of controlling expenses,
i.e., as eliminating the formal President’s banquet and
opting for a more intimate event that provides
opportunity for socializing and excellent choices in food,
beverage, and entertainment selections.
Although finances are stable, the greatest need still
exists for additional funding resources. Dr., Benninger
reported that the Association is still very highly market
dependent. He reported that Prodigy has performed well
with investments. He reminded the Association that in
2009, Dr. Crumley created a Sustainers’ Fund for donors
to make a contribution to the ALA. Last year, only
$3200 was received. Dr. Ossoff will be distributing some
key details on this fund and how fellows and friends of
the ALA may participate. He reiterated that donations
are vital to the Association’s operations and encouraged
everyone to get involved with the Sustainers Fund.
Respectfully submitted,
Michael S. Benninger, MD
Treasurer
14
REPORT OF THE EDITOR
Transactions
Dr. Courey reported that the 2010 Transactions have
been uploaded on the website and positive feedback
pertaining to the accessibility of the electronic copies
continues to be received from Fellows. Hard copies may
be printed by members or you may contact the
Administrator if you experience difficult in printing a
copy.
ALA Website
The traffic during the past year has increased
dramatically. There were more than 54K visits to the site
and multiple search engines were used. The majority of
visits were from the United States with others from Asia,
South America, and the UK.
He informed everyone that the user name of each Fellow
is that person’s first initial and last name. Upon request,
via the website, a temporary password will be sent. Dr.
Courey requested everyone to access the site and update
his/her profile with the accurate email address. This will
allow the distribution of email blasts to increase.
Publication
Dr. Courey reported there was a 65% rate of
manuscripts submitted from the 2010 annual meeting in
2010 that were published. This rate also includes some
manuscripts that originally were submitted for a poster
presentation. This is indicative of the excellent quality of
posters that increased the value to the contributor.
Respectfully submitted,
Mark S. Courey, MD
Editor
REPORT OF THE HISTORIAN
Dr. Ossoff reported on the passing of four Emeriti
fellows since the 2010 annual meeting. After presenting
a brief obituary for each deceased fellow. Dr. Ossoff
requested the observation of a moment of silence on
memory of Dr. John Frazer, Dr. Haskin Kashima, Dr.
Frank Ritter, and Dr. Joyce Schilds.
Respectfully submitted,
Robert H. Ossoff, DMD, MD, CHC
Historian
15
RECIPIENTS OF THE DE ROALDES AWARD
1928 Chevalier L. Jackson
1931 D. Bryson Delavan
1934 Harris P. Mosher
1937 Lee Wallace Dean
1943 Ralph A. Fenton
1949 George M. Coates
1951 Arthur W. Proetz
1954 Louis H. Clerf
1959 Albert C. Furstenberg
1960 Dean M. Lierle
1961 Frederick T. Hill
1966 Paul H. Holinger
1970 Francis E. LeJeune
1973 Lawrence R. Boies
1976 Anderson E. Hilding
1979 Joseph H. Ogura
1982 John J. Conley
1985 John A. Kirchner
1985 Charles M. Norris
1987
1988
1989
1990
1991
1992
1993
1994
1995
Walter P. Work
DeGraaf Woodman
John F. Daly
Joseph L. Goldman
William W. Montgomery
M. Stuart Strong
Douglas P. Bryce
Paul H. Ward
Hugh F. Biller
1996
1997
1998
1999
2000
2001
2002
2003
2004
2006
2007
2008
2009
2010
2011
Byron J. Bailey
George A. Sisson, Sr.
Stanley M. Blaugrund
Jerome C. Goldstein
Thomas C. Calcaterra
Eugene N. Myers
Robin T. Cotton
Gayle E. Woodson
Robert H. Ossoff
Stanley M. Shapshay
W. Frederick McGuirt, Sr.
Robert T. Sataloff
Andrew Blitzer
Marshall Strome
Gerald Healy
RECIPIENTS OF THE CASSELBERRY AWARD
1923 George Fetterolf
and Herbert Fox
1928 Ralph A. Fenton
and O. Larsell
1929 Richard A. Kern
and Harry P. Schenck
1929 Edward H. Campbell
1931 Arthur W. Proetz
1934 Anderson C. Hilding
1936 Francis E. LeJeune
and Joel J. Pressman
1939 H. Marshall Taylor
and Brien T. King
1940
1941
1946
1949
1962
1966
1968
1985
1987
1991
1993
1994
French K. Hansel
Noah D. Fabricant
Paul H. Holinger
Henry B. Orton
Hans von Leden
John A. Kirchner
and Barry D. Wyke
Joseph H. Ogura
H. Bryan Neel III
Joseph J. Fata
James L. Koufman
Frank E. Lucente
Ira Sanders
1998
1999
2006
2009
2010
Steven M. Zeitels
Clarence T. Sasaki
Kiminori Sato
Randal C. Paniello
Priya Krishna
RECIPIENTS OF THE NEWCOMB AWARD
1941
1942
1943
1944
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
Burt R. Shurly
Francis R. Packard
George M. Coates
Charles J. Imperatori
Harris P. Mosher
Gordon Berry
Gordon B. New
H. Marshall Taylor
John D. Kernan
William J. McNally
Frederick T. Hill
Henry B. Orton
Thomas C. Galloway
Dean M. Lierle
Gordon F. Harkness
Albert C. Furstenberg
Harry P. Schenck
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
Joel J. Pressman
Chevalier L. Jackson
Paul H. Holinger
Francis E. LeJeune
Fred W. Dixon
Edwin N. Broyles
Lyman G. Richards
Joseph H. Ogura
Walter P. Work
John A. Kirchner
Louis H. Clerf
Daniel C. Baker, Jr
Alden H. Miller
DeGraaf Woodman
John J. Conley
Francis W. Davison
Joseph L. Goldman
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
F. Johnson Putney
John F. Daly
Charles F. Ferguson
Charles M. Norris
Stanton A. Friedberg
William M. Trible
Harold G. Tabb
Daniel Miller
M. Stuart Strong
George A. Sisson
John S. Lewis
Douglas P. Bryce
Loring W. Pratt
William W. Montgomery
Seymour R. Cohen
Paul H. Ward
Eugene N. Myers
16
1994
1995
1996
1997
1998
1999
2000
Richard R. Gacek
Mark I. Singer
H. Bryan Neel III
Haskins K. Kashima
Andrew Blitzer
Hugh F. Biller
Robert W. Cantrell
2001
2002
2003
2004
2005
2006
2007
Byron J. Bailey
Gerald B. Healy
Steven D. Gray
Charles W. Cummings
Roger L. Crumley
Charles N. Ford
Robert H. Ossoff
2008
2009
2010
2011
Gayle E. Woodson
Marvin P Fried
Diane Bless
Jamie A. Koufman
RECIPIENTS OF THE GABRIEL F. TUCKER AWARD
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
Seymour R. Cohen
Charles F. Ferguson
Blair Fearon
Gerald B. Healy
John A. Tucker
Bruce Benjamin
John N. G. Evans
Joyce A. Schild
Robin T. Cotton
Haskins K. Kashima
Lauren D. Holinger
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Philippe Narcy
Bernard R. Marsh
Trevor J. I. McGill
Donald B. Hawkins
James S. Reilly
Ellen M. Friedman
C. Martin Bailey
William P. Potsic
Amelia F. Drake
Colin Barber
Seth Pransky
2009 William Crysdale
2010 Charles M Myer, III
2011 Mark Richardson
RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION AWARD
1988
1989
1990
1991
1992
1993
1994
1995
1996
Frank Netter
Shigeto Ikeda
Hans Littmann
Arnold E. Aronson
Michael Ter-Pogossian
C. Everett Koop
John C. Polanyi
John G. Batsakis
Ingo Titze
1997
1998
1999
2000
2001
2002
2003
2004
Matina Horner
Paul A. Ebert
Bruce Benjamin
M. Stuart Strong
and Geza J. Jako
Eugene N. Myers
Catherine D. DeAngelis
William W. Montgomery
David Bradley
2005
2006
2007
2008
2009
2010
2011
Herbert Dedo
Christy L. Ludlow
John A. Kirchner
Gerald B. Healy
Stanley M. Shapshay
Clarence T Sasaki
Lawrence DeSanto
RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION
RESIDENT RESEARCH AWARD
1990
1991
1991
1992
1993
1994
1995
1996
1997
David C. Green
Timothy M. McCulloch
Ramon M. Esclamado
David H. Henick
Gregory K. Hartig
Sina Nasri
Saman Naficy
Manish K. Wani
J. Pieter Noordzij
1998
1999
2000
2001
2002
2003
2004
2005
Michael E. Jones
Alex J. Correa
James C. L. Li
Andrew Verneuil
Dinesh Chhetri
Andrew Karpenko
Ichiro Tateya
Samir Khariwala
2007
2008
2009
2010
2011
Idranil Debnath
Tara Shipchander
David O. Francis
David O. Francis
Jeffreey Houlton
17
RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION
YOUNG FACULTY RESEARCH AWARD
1991
1992
1993
1994
1995
1997
Paul W. Flint
Yasuo Hisa
Jay F. Piccirillo
Hans J. Welkoborsky
Nancy M. Bauman
Ira Sanders
1998
2000
2001
2005
2006
2007
Kiminori Sato
Steven Bielamowicz
John Schweinfurth
Dinesh Chhetri
Suzy Duflo
Tack-kyun Kwon
2008
2009
2010
2011
Bernard Rousseau
Tsunehisa Ohno
I-Fan Theodore Mau
David Francis
18
THE MEMORIAL AND LARYNGOLOGICAL RESEARCH FUNDS
The Council earnestly requests that Fellows of the Association give consideration to making a special bequest to these
important funds, or to becoming a Benefactor.
MEMORIAL FUND DONORS
Daniel C. Baker, Jr
John F. Barnhill
August L. Beck
Gordon Berry
Stanley M. Blaugrund
William E. Casselberry
Cornelius G. Coakley
Lee Wallace Dean
Arthur W. De Roaldes
Fred W. Dixon
Charles F. Ferguson
George Fetterolf
Joseph L. Goodale
William E. Grove
Gordon F. Harkness
Frederick T. Hill
George E. Hourn
Samuel Johnston
John S. Lewis
H. Bryan Neel III
James E. Newcomb
Henry B. Orton
Lyman G. Richards
Myron J. Shapiro
Burt R. Shurly
Mark I. Singer
Lester T. Sunderland
H. Marshall Taylor
Walter H. Theobald
John A. Tucker
Francis L. Weille
Eiji Yanagisawa
BENEFACTORS
Sally Sample Aall
Mrs Daniel C. Baker, Jr
Edwin N. Broyles
Louis H. Clerf
Seymour R. Cohen
John J. Conley
John F. Daly
Francis W. and Mrs Davison
Stanton A. Friedberg
Thomas C. Galloway
Joseph L. Goldman
Robert L. Goodale
Edley H. Jones
A. P. Marchessini
Francis H. McGovern
Charles M. Norris
Samuel Salinger
Sam H. Sanders
Harry P. Schenck
Oliver W. Suehs
William M. Trible
Gabriel F. Tucker, Jr
DeGraaf Woodman
Zelda Radow
Weintraub Cancer Fund, Inc
19
PRESIDENTIAL ADDRESS
“The Evolution of Laryngology with an Eye to the Future”
ANDREW BLITZER, MD, DDS
New York, NY
Welcome fellow members and guests to the
American Laryngological Association’s
132nd annual meeting. I am humbled for
your trust of me for the leadership of the
ALA, and for having given me such a
wonderful year. I would also like to
recognize my son Peter and his wife, Erika
and thank them for being here with me.
I hope this will be an exciting and
educational experience for all of you. You
will see that the program includes many
contributions and a panel from our postgraduate members. For in fact, they are the
future of laryngology. I also have included 2
“State of the Art” lectures to share with you
cutting edge material. Dr. Steven Zeitels will
share with us the current state of Laser
laryngeal surgery, and Dr. Kristina
Simonyan will explain the current
understanding of neural control of laryngeal
function based on functional MRIs.
I hope our program will also show you how
far we have come in the past 200 years.
The origins of endoscopic laryngeal surgery
started with Bozzini who has become the
father of minimally invasive surgery. He
developed the “Lichtleiter that used a
speculum, candle light and mirrors for
illumination and cannulae to fit the orifice
(throat, rectum, urethra). However, his
device was condemned by the medical
community in Vienna.
This was followed by Benjamin Guy
Babington’s glottoscope (1829) mirror and
tongue depressor, and John Avery’s
laryngoscope with head mirror illumination
(1844). Manuel Garcia in 1854 a vocal
pedagogist, observed his own larynx using a
dental mirror and sunlight. He reported this
to the Royal Society of London in 1855
“Observations on the human voice”. This
resulted in the widespread use of mirror
laryngoscopy.
Ludwig Turck further explored the mirror
exam with sunlight, but failed due to mostly
cloudy days in Vienna. Johann Czermak, in
Pest, perfected it’s use with artificial light
and a curved mirror. Morrrell Mackenzie
said “Czermak freed laryngoscopy from the
clock and barometer”. Czermak also began
training other physicians including a number
of Americans. He is also credited on being
the first to take a photograph of the larynx.
Brunings developed a direct laryngoscope
for “autolaryngoscopy” that could be used in
the office. It applied pressure to laryngeal
20
Presidential Address
framework to better expose the anterior
commissure.
barred from hospitals being called dishonest
and unreliable practitioners.
Several Americans went to learn the mirror
examination from Czermak. Among them
was Horace Green who practiced in New
York City became the first specialist in the
US for throat and respiratory diseases. He
has been credited by Louis Elsberg, the first
President of the ALA, as the father of
American Laryngology. He used mirror
lighting and direct visualization for surgery
and application of caustic agents for
infectious diseases of the throat and was
called a “quack” by many other physicians.
A distinguished surgeon, Samuel D. Gross
of Phiadelphia, once introduced Jacob SolisCohen as a man who “devoted most of his
time to a cubic inch of the human anatomy.
Someday I suppose, we will have specialists
confining themselves to diseases of the
navel”.George Lefferts, Louis Elsberg and
Jacob Solis-Cohen founded the Archives of
Laryngology in NYC in 1880. The journal
and society were a mechanism to share
knowledge and stimulate research.
Elsberg in 1860 published the first formal
American article in laryngology and shortly
thereafter received the AMA gold medal for
his publication “Laryngoscopal Surgery:
Illustrated in the Treatment of Morbid
Growths within the Larynx”. His boyhood
friend, Jacob Da Silva Solis-Cohen, a Civil
War Surgeon was influenced by Elsberg and
became the first formal surgically trained
surgeon to become a laryngologist. He
introduced rigorous surgical training for
laryngology, and was probably the first
surgeon to cure a cancer using a
laryngofissure and hemilaryngectomy, in
1867. Elsberg and Solis-Cohen founded the
ALA in 1878. Elsberg’s first two
presidential addresses for the ALA were
“Laryngology
in
America”
and
“Laryngological Instruction”.
In October 1873, Clinton Wagner, who had
studied laryngology in Europe, helped found
the NY Laryngological Society (the first
laryngology society in the world), which
met on a regular basis in members homes. A
most notable meeting as in October of 1882,
when the guest of honor was Morrell
Mackenzie, who later founded the British
Laryngological Association. Wagner also
helped found the Metropolitan Throat
Hospital (the 1st of it’s kind in the US). This
was in part because laryngologists were
Killian by 1897 added suspension
laryngoscopy and rigid bronchoscopy to the
laryngeal surgical practice. Brunings added
many instruments at the turn of the last
century. A big change occurred when
general anesthesia and the operating
microscope where added in the 1960’s.
Professor Harold Hopkins added telescopic
rods for better visualization. Otto
Kleinsasser refined laryngeal microsurgery.
Dr. Isshiki reintroduced and refined
laryngeal framework surgery.
Johann Mikulicz in 1881 is credited with
doing the first successful esophagoscopy,
using the galvanized wire light and the
knowledge from Kussmaul’s observations of
sword swallowers. Mikulicz also added
removable optical devices to magnify the
images and in 1881 by developing an
instrument that could be angled to 30
degrees to navigate curves in body parts.
Clearly, the greatest clinical contributions to
endoscopic techniques for the upper
aerodigestive tracks were from Chevalier
Jackson.
Basil Hirschowitz, a South African,
developed a flexible fiber-optic endoscope,
but it was slowly adopted because it had
optical distortion and poor illumination.
Stroboscopy was developed to better
understand vocal fold motions for sound
21
Presidential Address
production. Ortel first introduced this
technology to slow down motion and better
understand the physiology of voice
production in 1878. Hans von Leden later
improved the equipment and art of
stroboscopy and it’s value in understanding
performers and laryngeal dysfunction.
Hirano further refined the technique to what
it is today.
In 1873, Billroth performed the first
laryngectomy for cancer. Alonso and Clerf
redefined these procedures in the 1940’s
Max Som, Joseph Ogura, John Kirchner
popularized partial laryngetomies and
supraglottic resections- 1958-60. Bruce
Pearson
described
the
sub-total
laryngectomy in 1981. Wolfgang Steiner
popularized
the
endoscopic
partial
laryngectomy in the 1990’s.
surgery for accurate cutting and ablation
with decreased bleeding in laryngeal
surgery. The first human laryngeal
transplant was performed 12 years ago by
our guest of Honor- Marshall Strome.
These are difficult economic times, but I feel
the future of our specialty is bright. We will
see
We will see the use of stem cells and growth
factors to regenerate replacement parts,
nerves, and epitelium.
Laser with wave lengths used for each
indication will be available, Targeted toxins,
viral vectors and growth promoters will be
easily applied to change biological behavior.
Electrical and magnetic fields will be used
to enhance biological systems, promote
healing, or change function.
The first laser were conceived by Charles
Hard Townes in 1957 while he ws at
Columbia University. Theodore Maiman, at
the Hughes Institute, constructed the first
working laser in 1960. The first human
surgery was of the eye, and Dr. Steven
Trokel at Columbia used the excimer laser
for corneal surgery.
All of this will happen, but the sharing of
knowledge and the continuation of the ALA
will take money and effort. We need you to
attend and participate in our meetings, help
support the science and development of our
new technology, help support and teach our
post-graduate members, and Help fund the
ALA initiatives
1970’s Polanyi and Jako worked with Strong
and Vaughn to add a CO2 laser to laryngeal
Thank you.
.
22
PRESIDENTIAL CITATIONS
Andrew Blitzer, MD, DDS
New York, NY
CHARLES N. FORD, MD
Madison, WI
Dr. Ford, originally from NYC, he received
his medical degree from the University of
Louisville and completed his residency
training at the Henry Ford Hospital in
Detroit. He served a chief of Otolaryngology
at the Randolph Air Force Base, San
Antonio, Texas. He then went to the
University of Wisconsin where he served on
the faculty, becoming the Professor and
Chairman
of
the
Department
of
Otolaryngology for many years. He is
presently Professor and Chairman Emeritus
of the Department. He is the recipient of
many awards and named lectureships around
the world, including the Newcomb Award, a
Presidential citation and the Baker lecturer
of the ALA and the Broyles-Maloney award
of the ABEA. He has been President of the
ABEA and the SUO. He is a master
laryngeal surgeon, and has devoted most of
his career to protecting the vocal cords with
minimally invasive techniques. His research
program evolved through promotion of
objective
voice
evaluation
and
videostroboscopy in clinical practice. He
was one of the first people to do in office
injection laryngoplasties and augmentation
using collagen, and continued the
development of bioimplants. He devised
new equipment to allow for these procedures
to be done efficiently. He also devoted much
of his research and career to understanding
vocal fold scarring and trying to reverse the
scar process to allow for normal mucosal
vibratory function for voicing. Chuck has
taught all of us so much over the years, and
deserves to be recognized for it. He is my
friend and has taught me many important
principles over the years. Chuck would have
been here but is a guest of honor at a
meeting in Italy, so we will honor him in
absentia.
23
Presidential Citations
MARVIN P. FRIED, MD
Bronx, NY
Dr. Marvin Fried is a graduate of the
City College of New York and received
his medical degree from Tufts
University.
He
trained
in
Otolaryngology
at
Washington
University in St. Louis with Dr. Ogura,
followed by a 3year fellowship at the
NIH. He then became the chief of
Otolaryngology of the Public Health
Service at Norfolk, VA. He began his
academic career at the Boston
Univ/Tufts Program in Boston. Shortly
thereafter, he joined the Harvard Med
School faculty as an Otolaryngologist at
the Beth Israel/ Brigham and Woman’s
Hospital in Boston, where he had a
distinguished career until he returned to
NYC as chair of the Department of
Otolaryngology of the Albert Einstein/
Montifiore Program. He is the recipient
of numerous awards including the
Fowler Award for his thesis from the
Triological Society; the Mark Award
from the American Society for Laser
Medicine and Surgery; and the
Newcomb Award from the ALA.
Marvin’s interests are diverse, but much
of his research work was involved with
laser surgery in combination with
robotics, and his continued development
of surgical training with simulators.
Marvin serves on 9 editorial boards and
is a reviewer for another dozen journals.
The amazing thing about Marvin is his
productivity and willingness to work for
all of our societies. He is a member of
scores of medical societies and has been
an officer of many including Board of
Directorsof the Academy; Chair Elect,
Specialty Advisory Council of the
Academy; President, American Society
for Laser Medicine and Surgery;
President, SYO; Councilor, Secretary
and President of the ALA; President,
American Rhinologic Society; and
President, NY Laryngological Society.
In recognition of his tireless work on our
behalf and specifically for all the
guidance he has given me during this
President’s year, and for his friendship I
award him with this citation.
24
Presidential Citations
ALLEN D. HILLEL, MD
Seattle, WA
Dr. Hillel, originally from New York City,
received his undergraduate and medical
degrees from Stanford University. He
trained in Otolaryngology at Stanford
followed by a fellowship in Head and Neck
Surgery also at Stanford. He then began his
academic career at the University of
Washington (UW) in Seattle, where he has
been ever since. He is a Professor of
Otolaryngology and also an Adjunct
Professor of Rehabilitation Medicine. He
was the chief of the VA service until 2002
and is the Director of the Neuromuscular
Clinic for Swallowing and Speech Disorders
and the Director of the Voice Clinic, both at
the UW. Al is the recipient of many awards
including the Fowler Award for his
Triologic thesis.
Al’s research has been mostly related to
neurological disorders affecting speech and
swallowing. His electromyographic studies
of the larynx are the gold standard for all of
the rest of us who use this testing. Al has
presented his work at many
international meetings. He has been the
director of a Laryngology Fellowship
Program which has turned out several
wonderful laryngologists in our ranks.
Al is a remarkable clinician and scientist
who always thinks out of the box and
has led us to a better understanding of
laryngeal movement disorders. Most of
all, Al is a friend.
25
Presidential Citations
GAYLE E. WOODSON, MD
Springfield, IL
Dr. Gayle Woodson was born in Texas and
received her undergraduate degree from
Rice University. She then received her
medical degree from Baylor College of
Medicine followed by surgical training at
Johns Hopkins and Otolaryngology at
Baylor. She then did 2 fellowships in
laryngology, one at Baylor followed by one
at the Institute of Laryngology & Otology in
London. Gayle’s academic career then
proceeded with a return to Baylor, then a
move to the University of California – San
Diego, the Univeristy of Tennessee,
University of Florida, and now as Chair of
the Department of Otolaryngology at the
Southern Illinois University School of
Medicine.
She has received numerous honors for her
contributions including: the Newcomb
Award, special presidential citation, and
guest of honor from the ALA; the Chevalier
Jackson Award of the ABEA; a member of
the Collegium; presidential citation from the
Academy; and Olga Jonasson Distinguished
Member Award, Association of Women
Surgeons. Aside from all of the amazing
surgical and scientific contributions, Gayle
has set a standard for all women in
Otolaryngology and has blazed trails
because of her excellence.
Gayle has served on numerous review
committees for the NIH, FDA, Resident
Review Committee and the American Board
of Otolaryngology. She has served on
numerous national societies including
President of the ALA, Board of Directors of
the AAO-HNS, President of SUO, Board of
Directors of the American College of
Surgeons, President of the Memphis Chapter
of the American Medical Women’s
Association, and the Council of AADO.
Gayle’s careful and thoughtful scientific
research landed her numerous VA, NIH and
University grants. She has been a master at
understanding laryngeal reflexes, laryngeal
motion and disordered motion. She has been a
pioneer of surgical procedures for vocal fold
paralysis, electromyography, botulinum toxin
therapy, sleep apnea, and vocal fold scarring.
She has taught courses and given lectures in all
corners of the world, representing the best that
American Otolaryngology has to offer. Gayle is
a real master, teacher, investigator, and a
friend.
26
Presidential Citations
EIJI YANAGISAWA, MD
New Haven, CT
Dr. Yanagisawa received his undergraduate
and medical degrees from Nihon University
in Tokyo, Japan. He then did his surgical
internship at the US Tokyo Army Hospital
followed by a residency in Otolaryngology
at the Yale-New Haven Medical Center
where he has remained for his entire career.
He is a clinical Professor of Otolaryngology
at the Yale Medical School and an
Attending Otolaryngologist at Yale and St.
Rafael’s Medical Centers. He is a humble
gentleman who is indeed a giant. He has
been President of several Otolaryngology
Societies;
honorary
member
of
Otolaryngology
societies
of
several
countries; and has been a guest lecturer
around the world. Though Eiji is a
multifaceted Otolaryngologist with great
talent, his major interest has been in
photography, videography and visual
documentation.
He has been the chairman of several world
medical film festivals and an award winner
for his contributions. He has also received
major awards from the ALA, ABEA, the
American
Otological
Society,
the
Triological Society, and the AAO-HNS for
his contributions.
He has published 341 original articles; 79
book chapters, 4 books, 233 presentations
and has created 77 videotapes or movies.
Eiji Yanagisawa is a giant in our field, has
always shared his knowledge with me and is
a friend.
27
Presidential Citations
STEVEN M. ZEITELS, MD
Boston, MA
Dr. Zeitels originally from New York, went
to Boston and received his undergraduate
and medical degrees from Boston
University.
He
then
trained
in
Otolaryngology at the combined BU/Tufts
program. It was during these years that he
developed skill and knowledge in lasers for
surgery from Stuart Strong, Charles Vaughn
and Geza Jako. After his residency he stayed
and did a year fellowship in Head and Neck
Oncology and then joined the BU academic
department where he remained until 1990
when he moved to the Harvard Medical
School. He is currently the Eugene B. Casey
Chair of Laryngeal Surgery, in the
Department of Surgery and a Visiting
Surgeon in the Division of Thoracic
Surgery. Steve is the Director of the Center
for Laryngeal Surgery and Voice
Rehabilitation - Massachusetts General
Hospital and the Director of a Laryngology
Fellowship Program at the Mass General
Hospital.
He is a member of 21 Medical Societies and
has held many offices including President of
the ABEA and Vice President for the
History of Otolaryngology Society. He has
scores of honors and named lectureships
bestowed upon him including the
Casselberry Award from the ALA; the
Chevalier Jackson Lecturer and the BroylesMaloney A, both from the ABEA. He has
lectured on various laryngeal surgical topics
worldwide. He is a avid student of the
history of our society with partners from
other disciplines such as cancer research,
engineering,
computers,
craft,
and
angogensis research, he surrounds himself
so that he can learn from others to make his
work the best.
He is honest and diligent about his work.
His current research includes the use of 532
lasers for vascular lesions and premalignant
lesions; use of avastin for papillomas and
premalignant lesions; biomaterials for the
regeneration of vocal folds; and optical
coherent tomography. Steve is really the true
renaissance scholar --he is historically well
versed; develops new ideas, learns from
others, collaborates for the betterment of the
specialty, teaches, publishes, and always
shares knowledge. He is indeed my great
friend.
28
INTRODUCTION OF THE GUEST OF HONOR
Marshall Strome, MD, MS
New York, NY
Andrew Blitzer, MD, DDS
Dr. Marshall Strome received his undergraduate
and medical education at the University of
Michigan, followed by a rotating internship at
the Philadelphia General Hospital, a residency
year in general surgery at the Harper Hospital in
Detroit and an Otolaryngology residency at the
University of Michigan. His early academic
career started at the Beth Israel Hospital of
Boston and Harvard Medical School. Marshall’s
success there was rewarded by his eventually
being a senior surgeon and Chief of
Otolaryngology at the Brigham and Woman’s
Hospital of Boston as well as the Chief of
Otolaryngology at the Beth Israel Hospital. He
then left to become the Chairman of
Otolaryngology at the Cleveland Clinic. He is
currently a member of the Head and Neck
Surgical Group of New York and an invaluable
part of the faculty for our Laryngology
Fellowship Program of the NY Center for Voice
and Swallowing Disorders.
Marshall’s teaching and surgical career has been
remarkable. He has changed the lives of
countless patients with his thoughtful medical
decisions and his skilled surgical procedures. He
has taught many of the finest otolaryngologists
in the country. Uniquely he in
1998 - Performed first total human laryngeal
transplantation;
2004 - Developed new endoscopic approach for
laryngeal cancer
2006 - Performed first robotic laser surgery for
laryngeal malignancy, and
2006 - Developed new surgical procedure for
aspiration
His list of awards are too numerous to recite, but
include:
--Medallion of Honor - Society of Facial Plastic
& Reconstructive Surgery
-- Sword of Saudi Arabia
-- Pioneers in Organ Transplantation@ - The
Discovery Channel
--Millennium Ogura Lecturer, Washington
University in St. Louis Medical School
-- Award of Excellence – Cleveland Clinic
Foundation
--Distinguished Professor Millennium Meeting,
British Otolaryngological Society
--Guest Lecturer of the Australian College of
Surgeons
He has been on the Council and President of
many Otolaryngology Societies including:
The Cartesian Society, SUO, and the ALA. He
has served on 13 editorial Boards of medical
journals. He is currently a member of the
prestigious NIH panel to review all of the
Human Transplantation Grants.
His major research interests include: -Cryotherapy and Laser Excision for Early Stage
CA of the Larynx; -- the Effect of Surgical
Hypothyroidism on Survical in Patients with
29
Guest of Honor
Advanced, Resectable Squamous Cell Cancer;
Myomucosal Flap for Vocal Restoration
Following Total Laryngectomy; Adoptive
Immunotherapy of Head and Neck Cancer With
Tumor Sensitized Ex-Vivo Activated TLymphocytes’ Human Laryngeal Transplantation; Selective Laryngeal Reinnervation in
Vocal Cord Paralysis: A comparison of
techniques; and, The role of irradiation and
drugs as immunomodulators for transplantation.
Over the past 40 years, Marshall has lectured to
medical groups around the world, with many
named lectureships and keynote speeches. He
has published more than 200 papers, 60 chapters
or invited papers, and 4 books. Marshall has
served as a leader and an inspiration to many of
us. Most of all he is my partner and dear friend.
30
PRESENTATION OF
THE AMERICAN LARYNGOLOGICAL ASSOCIATION
AWARD
to
LAWRENCE W. DeSANTO, MD
Scottsdale, AZ
Richard Hayden, MD
It is a great personal pleasure for me to make the
presentation of the ALA Award to Dr. Larry
DeSanto, an esteem colleague and good friend.
It is an easy award to make to a true pioneer.
Contrary to popular belief, Larry did not start
life as a pilot; he received his Bachelor and
Medical degrees at the University of Minnesota.
Six months after beginning his residency, Uncle
Sam "came" calling. He served as an Air Force
squadron flight surgeon in Thailand, Laos,
Turkey, Saudi Arabia and New Mexico.
Returning from service, Dr. DeSanto returned to
Mayo to complete his residency where he
trained more than 150 residents. Larry began
practicing otology but it gradually morphed into
Laryngology and Head and Neck Surgery. He
continued at Mayo in what became a stellar
career in Laryngology and Head and Neck
Surgery.
Larry migration to Arizona was a significant role
where he was a founding member of the Mayo
Clinic in Arizona and the first chair of its ENT
Department and Professor in the Mayo College
of Medicine. This was extremely momentous for
me as Larry provided me with such mentoring as
he continues to do today, along with his wisdom
and experience to residents in the “dessert.”
Thank you, Larry and Lora lee for your
continuing support and enrichment to the Oto
family.
The reason for the award is for the work in
microsurgery this man did that was pioneering
work in the 1960’s. It is very important to
realize that, and many of the young people in the
audience will not remember, that in the 1960’s,
most manipulations done in larynx were
performed under local anesthetic using
techniques considered archaic in the larynx.
With the mentorship of Ken Devine, Joseph
Ogura, and Mike Hinni, Larry was studying the
effects of doing a laryngoscopy under general
anesthetic. After obtaining the first laser at the
Mayo Clinic, Dr. DeSanto practiced, with much
criticism, the concept of transoral laser surgery
for early laryngeal cancer. He opened many
doors to plastic suspension that in turn opened
doors: 1) since the patient was under general
anesthetic, he could use the now obscure
suspension laryngoscope and 2) by using the
31
ALA Award
binocular view provided by the suspension
laryngoscope, he was an advocate of
microscope, when wider tubular laryngoscopes
had not yet been invented.
put together. Again he was way ahead of his
time, with the first quality of life study for
laryngeal cancer patients back in the 70’s before
the thought had crossed most minds.
Larry’s paper in 1970 on this actual issue of
suspension opened many doors. He stated to pry
open the door of surgical cynicism in the area of
micro-invasive adventures in the upper aerodigestive tract. During the period of the entry of
the laser, he closely collaborated with Joe Ogura
and Stuart Strong and others in the Boston
crowd on doing conservation laryngeal surgery
work. Larry’s paper in 1973 on early glottic
cancer
treatment
using
micro-invasive
techniques made him a headliner in Toronto.
When I showed up there, they were still a twitter
over the inaugural laryngeal conference Doug
Brice has put on in 1974.
The legacy of what this gentleman has produced
for our discipline is pretty evident today and
even this week’s meeting. If you look at the
rising enthusiasm that you see not only in this
room but the room next door regarding microinvasive techniques for dealing with a multitude
of cancers of the upper aero-digestive tract. The
result has been astounding.
That was really when this puppy got inspired
about head and neck cancer. If you look at the
work that was being done by microlaryngoscopic and what it brought, you will have
to admit, it was an important addition. It
branched out the multidisciplinary multi-center
database that we use today with TLM that Larry
For the outstanding and valuable contributions
Larry has made to our laryngology, we, as a
specialty, should be widely grateful. I personally
find that his mentorship of stars such as Bruce
Pearson, Kerry Olsen, and Mike Hinni have
allowed people who came from a more jaded
past of more aggressive therapy to really see the
light in the millennium.
We are grateful Larry, and it is with a lot of
enthusiasm that I welcome you to the ranks of a
very esteem group of recipients of this wellearned Award. I thank you and congratulate
you.
32
PRESENTATION OF THE GABRIEL F. TUCKER AWARD
to
Mark Richardson, MD, MScB, MBA
Portland, Oregon
Ellen Friedman, Houston, Texas
It is really a pleasure to be here and I know that
john is disappointed that he will be unable to
present this award because he does take a great
deal of pride in his family’s history and
contributions. And he himself received a
presidential citation this year with the ABEA
and his family continues to be productive in
contributing
As it mentions, the Gabriel F. Tucker Award
was established in 1987 and it is given to an
individual
who
has
made
significant
contributions to the field of pediatric
laryngology or the ALA or both. So it is truly an
honor to give this to my close friend and
colleague, Dr. Mark Richardson. On this slide,
you get to see a photo of Gabriel F. Tucker Sr.
and Gabriel F. Tucker, Jr. both of whom were
accomplished otolaryngologists. This is an
example of the Tucker Award and one of the
things that John usually talks about is the
incredible detail of this beautiful memorial
paperweight or medal. It has a lot of detail and it
is quite beautiful and it something that we hope
Mark will enjoy and display prominently in his
office.
This year’s winner of this Award is Mark
Richardson who is a pediatric otolaryngologist
as a beginning but he is just so much more. I’d
like to tell you a little about him. He completed
his residency at the Medical University of South
Carolina, a surgical internship at the University
of South Florida and returned to MUSC for an
otolaryngology residency. Mark completed
fellowship training in pediatric laryngology
under the leadership of Robin Cotton in
Cincinnati and they maintain a close and
important relationship to this day. Following his
fellowship, he joined the University of
Washington faculty in Seattle and he was the
University of Washington’s first pediatric
otolaryngologist beginning a group which now
has grown substantially and is of considerably
significance in the academic world. Following
his 15 year tenure at UW with Charles
Cummings, he followed Charlie to John
Hopkins where he spent a considerable amount
of time and subsequently becoming the Vice
Chairman and the Bordley Professor of
Otolaryngology in the Department of
Otolaryngology at Hopkins. Dr. Richardson also
studied beyond otolaryngology and received a
33
Gabriel F. Tucker Award
Master of Science in Business in 1998 and his
MBA in 2000 – both from John Hopkins
University. This definitely was a great move for
him because in 2007, Mark was appointed Dean
of the School of Medicine at Oregon Health and
Sciences University in Portland, Oregon
following a year of services as interim dean.
Dr. Richardson is a member of numerous
national organizations including the AAO-HNS,
ABEA and ASPO. He has been the recipient of
several
teaching
presentations.
awards
and
society
This gives me great pride because there are very
few or a scant number of medical school deans
of medical schools around the country who are
otolaryngologists and specifically pediatric
otolaryngology.
It is truly with great pride, admiration and
pleasure that I am able to introduce Dr. Mark
Richardson, the 2011 Gabriel F. Tucker Award
winner.
34
INTRODUCTION OF THE STATE OF THE ART LECTURER
KRISTINA SIMONYAN, MD, PhD
ANDREW BLITZER, MD, DDS
Dr. Simonyan received her medical degree
from Yerevan State Medical University in
Armenia. She then did a residency in
Otolaryngology, at the Georg- August
University in Göttingen, Germany followed
by a PhD degree in Neurophysiology from
the University of Hannover, Germany as
well as a second Doctor of Medicine degree
from Univ of Gottingen.
Univiversity of Pittsburgh. Kristina spent
five years in the Laryngeal and Speech
section at the National Institute of Health.
She then became a visiting fellow at several
Universities including Neuroimaging at the
Massachusetts General Hospital and at the
is uniquely trained and is a world expert in
neuroimaging and neural control of the
larynx. She will now explain all of this to us.
She currently holds appointments in the
Neurology and Otolaryngology departments
at Mt. Sinai Medical School in NYC. She
has won numerous awards for her work. She
35
STATE OF THE ART LECTURE
Functional MRI and Understanding the Neural Control of the Larynx
Kristina Simonyan, MD, PhD
New York, New York
In my talk, I want first to introduce you to
what we knew before the advent of
neuroimaging about the neural control of the
larynx, mostly based on electrical stimulation
and tract tracing studies. Then, I will talk
about current research with the use of
different neuroimaging techniques, and
finally, I will conclude with some open
questions for future research.
As we know, the laryngeal functions are
numerous and some of them are vital, such as
breathing and swallowing. All laryngeal
functions can be divided into three groups,
including
breathing,
respiration,
and
phonation. Some of these functions, such as
breathing, coughing, swallowing, laughing,
are innate behaviors that can also be produced
on demand. Some of them, for example,
speech and song, are only voluntary
behaviors, while others, such as sneezing, are
only innate behaviors.
The main question I want to focus in my talk
today is how the brain controlling voice
production.
It appears that central nervous control of
voice production is organized in an
hierarchical manner that is different brain
levels control vocalizations of different
complexity. The lowest level within this
hierarchical control is represented by the
phonatory sensory and motor nuclei and
reticular formation of the brainstem
(subsystem I). These structures are
responsible for the coordination of laryngeal,
articulatory and respiratory activities for
production of innate vocalizations. An
example can be a cry of newborn at birth.
This type of vocalization is
an innate behavior that does not require prior
learning. Even anencephalic infants, who
lack the entire forebrain but have an intact
brainstem, are able to produce these types of
vocalizations. As child growth, these
vocalizations become under voluntary control.
For example, a child can cry without obvious
painful stimulus and suppress crying at the
presence of painful stimulus. For this type of
vocal control, the brainstem structures need
an input from higher subcortical regions, such
as periaqueductal gray of the midbrain (PAG).
The PAG is positioned to couple external
stimuli with internal motivational vocal
reactions. It also receives heavy input from
the limbic structures, such as hypothalamus,
amygdala, red nucleus, to shape the emotional
character of vocalizations. The PAG receives
input from the anterior cingulate cortex
(ACC), which is involved in the voluntary
control of emotional vocalizations. When this
36
State of the Art Lecture
region is lesioned in stroke patients, they are
able to speak and vocalize but lack emotional
intonations of vocalizations. The PAG and
ACC together with the limbic input structures
form the subsystem II. Finally, the highest
level of voice control is represented in the
laryngeal/orofacial motor cortex and its input
and output projections (subsystem III). This
level is involved in the control of such highly
skilled and learned vocal behaviors as
speaking and singing. When the laryngeal
motor cortex (LMC) is lesioned bilaterally in
neurological patients, these patients are not
able to speak or sing but they are still able to
produce some other types of vocalizations,
such as grunting, crying, laughing. This
indicates the parallel organization of voice
production control by the ACC-PAG and by
the LMC.
For the remainder of my talk, I want to focus
your attention on understanding the neural
control of the larynx by the LMC.
Methods to understand neural basis of human
behaviors and cognition are based, among
others, on brain lesioning studies and
neuropsychology; electrophysiology and
neuroanatomy; pharmacological and genetic
studies; and neuroimaging.
Electrical stimulation measures function of a
neuron or a neural network by using
excitation of cell membrane with an electric
current. It can be direct with penetrating or
surface electrodes and indirect with the use of
trascranial magnetic stimulation (TMS).
Electrical stimulation studies can be
conducted in both humans and animals.
Neuroanatomical tract tracing assesses
connectivity between brain regions by using
dyes that are transported along the axons. This
transport can be anterograde from the cell
body to synapse or retrograde from synapse to
the cell body. Because of the invasiveness and
toxicity, neuroanatomical tract tracing can be
used only in animals and postmortem human
brain tissue.
Our first knowledge about the central control
of laryngeal movements based on direct
electrical stimulation studies comes from mid
1930s. In 1936, German neurologist Oscar
Foester was first to report on bilateral
movement of the vocal folds with electrical
stimulation of the motor cortex. A year later,
in 1937, Wilder Penfield and colleagues
described vocalization representation in the
motor cortex of a man. In 1950s and 1960s,
Woolsey and others observe similar larynx
representation in the motor cortex of the
monkey, while Hast and others were not able
to confirm the motor cortical larynx
representation in the dog and cat.
Hast and colleagues were further able to map
the representation of separate laryngeal
muscles in the motor cortex of the rhesus and
squirrel monkeys by using direct electrical
stimulation with simultaneous laryngeal
EMG. They reported, however, the laryngeal
muscle representations in the premotor cortex
(area 6) with the TA and CT response times
ranging between 20 and 40 ms.
Almost 30 years later, with the use of TMS,
two studies were able to identify the TA and
CT representation in human motor cortex. In
contrast to the monkey, they reported the
muscle representations in the primary motor
cortex (area 4) with faster TA and CT
response times, ranging between 7.3 and 11.3
ms.
While most of neuroanatomical studies have
been conducted in non-human primates with
only 2 studies in human postmortem tissue, it
has been hypothesized that humans and nonhuman primates share similar laryngeal motor
cortical networks, except the direct projection
between the LMC and nucleus ambiguus of
the brainstem, where the laryngeal
motoneurons reside.
In summary, the larynx representation within
the primary motor cortex and its direct
connection with the nucleus ambiguus may
have enabled faster neuronal transmission for
37
State of the Art Lecture
the direct control of vocal gestures for speech
and song production.
These neuroimaging methods can safely be
used in both humans and animals.
In contrast, the larynx representation within
the premotor cortex and its indirect
connections with the nucleus ambiguus in
non-human primates may explain their limited
ability to learn and control their vocalizations
voluntarily.
Almost half a century after the seminal work
by Penfield and others, neuroimaging studies
starting from early 2000s looked into mapping
of the laryngeal representation in humans to
confirm the results of TMS studies. A series
of studies by different groups have been
conducted with the use of different laryngeal
tasks, such as speech, singing, coughing,
sniffing, production of syllables and glottal
stops, whisper, whimper, in order to map the
larynx in the human motor cortex. These
studies were able to identify a more discrete
region within the human primary motor cortex
(area 4p) for the larynx representation as an
organ compared to a much wider region for
vocalization representation as a behavior
mapped by Penfield and colleagues.
Our knowledge about the neural control of the
larynx would have probably stopped here if
not for the advent of neuroimaging.
Neuroimaging is unique: while most of the
other techniques permit examination of only
one neural entity at a time, brain imaging
allows the study of the whole brain at once.
Neuroimaging is based on hemodynamicmetabolic methods, such as functional MRI
(fMRI) and positron emission tomography
(PET); neuroanatomical methods, such as
high-resolution MRI and diffusion tensor
imaging (DTI); electromagnetic methods,
such as electroencephalography (EEG) and
magnetoencephalography (MEG).
PET measures brain function, metabolism,
neurotransmission, and other neurchemical
pathways by using positron emitter decay
resulting into 2 gamma rays. It has low
temporal resolution (about 30-60 sec) with
spatial resolution of 5-10 mm. FMRI
measures brain function by using magnetic
properties
of
oxygen:
deoxygenated
hemoglobin
is
paramagnetic,
while
oxygenated hemoglobin is diamagnetic.
FMRI has also low temporal resolution of
about 5 sec with spatial resolution of a few
mm.
High-resolution
MRI
measures
brain
structure, such as gray matter volume, cortical
thickness, etc., by using radio waves to
interrogate protons in water molecules. It can
have a very high spatial resolution. DTI
measures the organization of white matter by
using water molecule displacement along the
axons. It also can be of very high resolution.
Compared to the rhesus monkey, the human
larynx representation appears more dorsally
from the Sylvian fissure in the primary motor
cortex.
Let’s look now into the functional and
structural organization of this region in
humans by considering two major laryngeal
functions, breathing and speaking.
In an fMRI study of syllable and breathing
production in healthy human subjects, we see
that both these tasks activate similar brain
regions and this activation is fairly bilaterally
distributed over the both hemispheres.
However, compared to breathing, voice
production elicits larger brain activation in the
auditory cortex, while the PAG is active
during voice production only.
To understand how the functional networks of
the LMC are organized during production of
syllables and breathing, we used functional
connectivity analysis (psycho-physiological
interactions analysis). We found that despite
the bilateral brain activation during both
syllable and breathing production, the
functional LMC networks controlling syllable
38
State of the Art Lecture
production are left lateralized, while
functional LMC networks controlling
breathing have bilateral distribution without
hemispheric lateralization.
In contrast to this, structural LMC networks
(assessed using DTI and tractography)
controlling both syllable and breathing
production are bilaterally distributed without
hemispheric lateralization.
These findings suggest that functional
networks controlling different laryngeal
functions are built upon a common bilateral
structural network of the LMC. Bilateral
organization
of
functional
networks
controlling
breathing
supports
its
indispensable role in all types of laryngeal
behaviors,
whereas
significant
lefthemispheric lateralization of functional
networks controlling simple but highly
learned syllable production suggests their role
in production of speech.
While, through all these studies, we start to
understand better how neural control of the
larynx is organized in humans, we still don’t
know much about the neurochemical
underpinnings of speech control. Our only
knowledge comes from the studies in
songbirds and neurological patients. The
LMC receives a number of excitatory
(glutamatergic), inhibitory (GABAergic) and
modulatory (dopaminergic) inputs. In a study
in healthy human subjects, we started
exploring the dopaminergic control of speech
production.
We asked the subjects to first rest in the PET
scanner for some time and then produce short
English sentences. We examined their
dopamine levels during resting and speaking
with the use of [11C]raclopride, a D2/D3
receptor antagonist, which is being replaced
by newly released dopamine during task
production. We found that speaking was
associated with increased dopamine release in
the bilateral dorsal caudate nucleus, left
posterior caudate nucleus and left dorsal and
posterior putamen. We further found that
dopamine release in the left dorsal putamen is
significantly correlated with the brain
activation in the same region during speech
production. This suggests left lateralized
coupling between dopamine release and
striatal activation during normal speech
production, which may underlie the left
lateralization of brain networks during speech
and syllable production.
In summary, compared to non-human
primates, the human larynx is represented in
the primary motor cortex (area 4) more
dorsally from the Sylvian fissure. Functional
but not structural networks of the human
LMC show left hemispheric lateralization
during production of learned syllables but not
innate breathing. Dopamine release during
speech production is lateralized to the left
striatum and is coupled with striatal
activation.
Finally, there are several unknowns regarding
the central control of the larynx. Some of
them include:
Representation of the larynx in the primary
somatosensory cortex;
Characterization of subcomponents of the
laryngeal motor cortical networks in nonhuman primates, healthy humans and patients
with neurological voice and speech disorders;
Organization of functional laryngeal motor
cortical networks during different laryngeal
behaviors;
Interactions between laryngeal motor cortical
and limbic pathways of voice control;
The temporal characteristics of the LMC
activity;
The role of neurotransmitters (GABA,
dopamine, glutamate) in voice and speech
control.
39
INTRODUCTION OF THE STATE OF THE ART LECTURER
STEVEN M. ZEITELS, MD, FACS
ANDREW BLITZER, MD, DDS
Dr. Zeitels is originally, a New Yorker who
went to Boston where he received his
undergraduate and medical degrees from
Boston University. He then trained in
Otolaryngology at the combined BU/Tufts
program. It was during these years that he
developed skill and knowledge in lasers for
surgery from Stuart Strong, Charles Vaughn
and Geza Jako. After his residency he stayed
and did a year fellowship in Head and Neck
Oncology and then joined the BU academic
department where he remained until 1990
when he moved to the Harvard Medical
School.
honors and named lectureships bestowed
upon him including the Casselberry Award
from the ALA; the Chevalier Jackson
Lecturer for the ABEA; and the BroylesMaloney award from the ABEA.
Steven has lectured on various laryngeal
surgical topics worldwide. He is a avid
student of the history of our craft, he
surrounds himself with partners from other
disciplines such as cancer research,
engineering, computers, and angiogenesis
research, so that he can learn from others to
make his work the best. He is honest and
diligent about his work.
He is currently the Eugene B. Casey Chair
of Laryngeal Surgery, in the Department of
Surgery and a Visiting Surgeon in the
Division of Thoracic Surgery. Steve is the
Director: Center for Laryngeal Surgery and
Voice Rehabilitation - Massachusetts
General Hospital and the Director of a
Laryngology Fellowship Program at the
Mass General Hospital. He is a member of
21 Medical Societies and has held many
offices including President of the ABEA and
Vice President for the History of
Otolaryngology Society. He has scores of
Dr. Zeitels’ current research includes the use
of 532 lasers for vascular lesions and
premalignant lesions; use of avastin for
papillomas and premalignant lesions;
biomaterials for the regeneration of vocal
folds; and optical coherent tomography.
Steve is really the true renaissance scholar -he is historically well versed; develops new
ideas, learns from others, collaborates for
the betterment of the specialty, teaches,
publishes, and always shares knowledge. He
is indeed my great friend.
40
STATE OF THE ART LECTURE
Current and Future Directions in Laser Surgery of the Larynx
Steven M. Zeitels, MD, FACS
Boston, Massachuesetts
I would like to begin this
presentation by expressing my appreciation
to Dr. Blitzer and the council of the
American Laryngological Association for
providing me with the opportunity to share
my perspectives on the current and future
directions in laser surgery of the larynx. I
have been remarkably fortunate to have been
trained by those who pioneered laser
surgery. I would like to thank Geza Jako,
Stuart Strong, and Charles Vaughan for their
mentorship and for reviewing the origins of
laser surgery. They provided key material
for this lecture so that I might provide you
with their insights about this exciting period
of innovation, which laid the foundation for
many of our current approaches to
endoscopic laryngeal surgery.
Since the introduction of lasers to
medicine in the 1960s, there has been an
inextricable linkage between lasers in
medicine and their use in Laryngeal
Surgery. Consequently, laser development
has provided a catalyst for substantial
innovation in laryngeal surgery over the past
50 years. In 1966, Geza Jako [1, 2]
partnered with Thomas Polanyi [3] to
initiate mammalian investigations with a
carbon dioxide (CO2) laser. Jako, who had
previously
introduced
microlaryngeal
surgery [4], was an intrepid innovator. He
had the foresight to realize the importance of
the technical advantages lasers provided for
soft-tissue dissection, as well as the heuristic
value to train surgeons in microlaryngeal
surgery who were having difficulties with
the new art due to the need for controlling
microlaryngeal hand-instruments with their
non-dominant
hand
under
high
magnification.
The research team was
completed [5] when Stuart Strong [6, 7] and
Charles Vaughan [8, 9] joined Jako and
Polanyi. The three pioneering surgeons
were well aware that minimally-invasive
surgery had its origins in Laryngology [10]
and that over time more procedures would
be done employing advances in laser
technology. Furthermore, they espoused the
philosophy of Jacob Solis Cohen [11]
(America’s first head and neck surgeon and
2nd president of the ALA) who made clear in
the 19th century that to optimally manage
laryngeal disease, an individual must be
equally skilled in transoral and transcervical
surgical techniques.
The initial application for the CO2
laser was to ablate or resect epithelial
diseases (dysplasia [12], papillomatosis [13],
cancer [7-9, 14]) and these disorders still
comprise the majority of cases best suited
for laser use today. Benign phonatory
mucosal lesions (nodules, polyps, cysts) are
generally better removed with cold
41
State of the Art Lecture
instruments as a subepithelial resection
approach. [15-17] The CO2 laser results in
unavoidable heating of the underlying
pliable delicate superficial lamina propria
[18] and the overlying normal epithelium.
This precluded an optimal subepithelial
resection predisposing to deleterious effects
on phonatory mucosal wave propagation and
voice production. In the latter 20th century,
academic camps created synthetic conflict
suggesting unidimensional support of cold
instruments versus CO2 laser when
performing phonomicrosurgery. In fact,
Jako had initiated both approaches to be
synergistic
and
complementary
not
competitive.
Over the past 15 years, angiolytic
lasers {532 nm Potassium Titanyl Phosphate
(KTP) laser and 532 nm Pulsed-Dye laser
(PDL)} have facilitated great advancements
in laryngeal surgery. These lasers were
designed based on Rox Anderson’s seminal
theory of selective photothermolysis [19-21]
a concept that he developed to enhance the
treatment of vascular malformations in
infants’ skin. Accordingly, as we initiated
intensive collaboration with Anderson, he
noted the similarity of the therapeutic goal
in treating an infant’s dermis and a human
vocal fold, ‘maintaining pliability’. Bower
et al [22] and McMillan et al [23] reported
early experience with the yellow-light 585
nm PDL for treating recurrent respiratory
papillomatosis (RRP). We subsequently
reported a substantially larger experience
[24] and broadened the application by
treating dysplasia [25], cancer [26], ectasias,
and varices. [27] The fiber-based delivery
systems of the angiolytic lasers allowed for
initiation of office-based laryngeal laser
surgery with local anesthesia, which was a
key innovation in laryngeal surgery. [28, 29]
Office-based laryngeal laser surgery had
been previously conceived by Blitzer et al
[30] with the CO2 laser but the effort was
not continued due to difficulties with the
technology.
We abandoned use of the CO2 laser when
the Thulium laser [31] was introduced,
which
offered
soft-tissue
treatment
characteristics of the CO2 laser but
employed a .3mm -.6mm fiber. About the
same time, a retrofitted wave-guide was
introduced for the CO2 laser [32] which
many surgeon use today for endolaryngeal
cancer surgery.
Because of key advantages of the
532 nm KTP laser, we have not used 585 nm
PDL since 2005. These advantages of the
KTP laser are well delineated in the
literature [33-35] but are highlighted by the:
1. ability to greatly vary pulse-width even to
continuous wave, 2. ability to use
substantially smaller fibers (.3mm versus
.6mm), 3. reliability (solid-state technology).
These advantages result in greater precision
and facility, which is invaluable in the
challenging scenario of awake office-based
laryngeal surgery. These advantages can be
easily seen and taught by using the chick
chorioallantoic membrane [36, 37], which is
an effective economic live perfusing model
that simulates the microcirculation of human
vocal folds.
Moreover, the KTP laser has
become
our
most
commonly-used
instrument in transoral laryngeal surgery.
We reported our one-year utilization in
2009, which revealed that of the 324
microlaryngoscopic procedures and 386
office-based procedures, 50% were done
with the KTP laser. [38] The KTP laser has
proven to be remarkably versatile since its
settings can be adjusted to effectively
involute ectasias and varices of singers
while also being very effective for treating
extensive carcinoma.
KTP laser treatment of glottic
cancer has allowed us to maintain cure rates
of ~95% for T1 disease and >85% for T2
lesions, while achieving our best voice
results to date. This has been accomplished
by treating bilateral disease in a staged
42
State of the Art Lecture
fashion taking care to preserve anteriorcommissure architecture and employing
ultra-narrow margins. [26] This is done by
observing the difference in combustion of
angiogenic malignant tissue as compared
with normal soft tissue of the vocal fold.
We believe that vocal folds (early disease)
are a privileged site due to an extremely low
incidence of regional and distant metastasis
as compared with other sites of the upper
aerodigestive tract cancer. This biological
difference allows for two-staged treatment,
which provides a key advantage for
achieving a better vocal outcome. Since
curing early glottic is not difficult with any
adequate treatment, voice outcome and
preservation of future treatment options (e.g.
radiation) are the key metrics for success.
To date, we have treated over 150 patients
with KTP laser treatment and the majority
have greater than three-year follow up.
The near-term and mid-term horizon
for employing laser technologies to further
enhance laryngeal surgery is promising.
Integrating fiber-based laser technologies
should soon improve the growing
advancements in transoral robotic surgery.
[39] Laser technologies will also likely
provide subepithelial softening of scarred
vocal folds, which will allow for injectable
implants to restore vocal-fold mucosal
pliability, the primary mechanical deficit
responsible for the majority of unresolved
hoarseness. [40, 41] Finally, it is likely that
there will be further integration of
antiangiogenesis pharmacological agents
with angiolytic lasers, which will lead to
more effective treatment of epithelial
diseases of the larynx. [42]
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
References
1.
Jako, G.J., Kleinsasser, O,
Endolaryngeal micro-diagnosis and
Microsurgery. Reprint from the
Annual Meeting of the American
Medical Association, 1966.
12.
Jako, G.J., Laser Surgery of the
Vocal Cords. Laryngoscope, 1972.
82: p. 2204-2215.
Polanyi, T., Bredermeier, HC, Davis
TW, Jr., A CO2 laser for surgical
research. Med. Biol. Eng. Comput.,
1970. 8: p. 548-558.
Jako, G.J., Correspondence
documents between Geza Jako and
the Stuemar Instrument Company.
1962.
Strong, M.S., Jako, G. J., Polanyi,
T., Wallace, R. A., Laser surgery in
the aerodigestive tract. Am J Surg,
1973. 126(4): p. 529-33.
Strong, M.S., Jako, G.J., Laser
Surgery of the Larynx: Early
Clinical Experience with
Continuous CO2 Laser. Annals of
Otology, Rhinology, &
Laryngology, 1972. 81: p. 791-798.
Strong, M.S., Laser excision of
carcinoma of the larynx.
Laryngoscope, 1975. 85: p. 12861289.
Vaughan, C.W., Transoral
laryngeal surgery using the CO2
laser. Laboratory experiments and
clinical experience. Laryngoscope,
1978. 88: p. 1399-1420.
Vaughan, C.W., Strong, M.S., Jako,
G.J., Laryngeal carcinoma:
transoral treatment using the CO2
laser. American Journal of Surgery,
1978. 136: p. 490-493.
Zeitels, S.M., Healy, G. B.,
Laryngology and Phonosurgery.
New England Journal of Medicine,
2003. 349(9): p. 882-92.
Zeitels, S.M., Jacob Da Silva SolisCohen: America's First Head and
Neck Surgeon. Head and Neck
Surgery, 1997: p. 342-346.
Strong, M.S., Laser management of
premalignant lesions of the larynx.
Can J Otolaryngol, 1974. 3(4): p.
560-3.
43
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13.
14.
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20.
Strong, M.S., Vaughan, C.W.,
Cooperband, S.R., Healy, G.B.,
Clemente, M.A., Recurrent
Respiratory Papillomatosis:
Management with the CO2 Laser.
Annals of Otology, Rhinology &
Laryngology, 1976. 85: p. 508-516.
Vaughan, C.W., Strong, M.S.,
Shapshay, S.M., Treatment of T1
and In Situ Carcinoma: The
Transoral Approach.
Otolaryngological Clinics of North
America, 1980. 13: p. 509-513.
Zeitels, S.M., Laser Versus Cold
Instruments for Microlaryngoscopic
Surgery. Laryngoscope, 1996. 106:
p. 545-552.
Zeitels, S.M., Atlas of
Phonomicrosurgery and Other
Endolaryngeal Procedures for
Benign and Malignant Disease.
2001, San Diego: Singular.
Zeitels, S.M., Hillman, R.E.,
Desloge, R.B., Mauri, M., Doyle,
P.B., Phonomicrosurgery in Singers
& Performing Artists: Treatment
Outcomes, Management Theories,
& Future Directions. Annals of
Otology, Rhinology, &
Laryngology, 2002.
111(Supplement 190): p. 21-40.
Hirano, M., Phonosurgery: Basic
and Clinical Investigations.
Otologia (Fukuoka), 1975. 21: p.
239-442.
Anderson, R., Parrish, J., Selective
photothermolysis: precise
microsurgery by selective
absorption of pulsed radiation.
Science, 1983. 220: p. 524-7.
Anderson, R.R., Parrish, J.A.,
Microvasculature can be selectively
damaged using lasers: A basic
theory and experimental evidence in
human skin. Lasers Surg Med, 1981.
1: p. 263-276.
21.
22.
23.
24.
25.
26.
27.
28.
Anderson, R.R., Jaenicke, K.F.,
Parrish, J.A., Mechanisms of
selective vascular changes caused
by dye lasers. Lasers Surg Med,
1983. 3: p. 211-215.
Bower, C.M., Flock, S., Waner, M.,
Flash pump dye laser treatment of
laryngeal papillomas. Annals of
Otology, Rhinology, and
Laryngology, 1998. 107: p. 10011005.
McMillan, K., Shapshay, S. M.,
McGilligan, J.A., A 585-nanometer
pulsed dye laser treatment of
laryngeal papillomas; preliminary
report. Laryngoscope, 1998. 108: p.
968-972.
Franco, R.A., Zeitels, S.M.,
Farinelli, W.A., Anderson, R.R.,
585-NM Pulsed Dye Laser
Treatment of Glottal Papillomatosis.
Annals of Otology, Rhinology and
Laryngology, 2002. 111: p. 486492.
Franco, R.A., Zeitels, S. M.,
Farinelli, W. A., Faquin, W.,
Anderson, R. R., 585-nm pulsed dye
laser treatment of glottal dysplasia.
Ann Otol Rhinol Laryngol, 2003.
112: p. 751-8.
Zeitels, S.M., Burns, J.A, Hillman,
R.H, Anderson, R.R.,
Photoangiolytic Laser Treatment of
Early Glottic Cancer: A New
Management Strategy. Annals of
Otology, Rhinology, &
Laryngology, 2008. 117
(supplement 199): p. 1-24.
Zeitels, S.M., Akst, L., Burns, J. A.,
Hillman, R. E., Broadhurst, M.S.,
Anderson, R. R., Pulsed Angiolytic
Laser Treatment of Ectasias and
Varices in Singers. Ann Otol Rhinol
Laryngol, 2006. 115: p. 571-580.
Zeitels, S.M., Franco, R. A., Jr.,
Dailey, S. H., Burns, J. A., Hillman,
R. E., Anderson, R. R., Office-based
treatment of glottal dysplasia and
44
State of the Art Lecture
29.
30.
31.
32.
33.
34.
35.
36.
papillomatosis with the 585-nm
pulsed dye laser and local
anesthesia. Ann Otol Rhinol
Laryngol, 2004. 113(4): p. 265-76.
Zeitels, S.M., Akst, L., Burns, J. A.,
Hillman, R. E., Broadhurst, M.S.,
Anderson, R. R., Office Based
532nm Pulsed-KTP Laser
Treatment of Glottal Papillomatosis
and Dysplasia. Ann Otol Rhinol
Laryngol, 2006. 115: p. 679-685.
Blitzer, A., Office-Based Laser
Surgery of the Laryngopharynx.
Joint International Congress on
Minimally Invasive Techniques in
Neurosurgery and Otolaryngology.
1995, Pittsburgh.
Zeitels, S.M., Burns, J.A., Akst,
L.M., Hillman, R.E., Broadhurst,
M.S., Anderson, R. R., Office-Based
and Microlaryngeal Applications of
a Fiber-Based Thulium Laser. Ann
Otol Rhinol Laryngol, 2006. 115: p.
891-896.
Zeitels, S.M., et al., Carbon dioxide
laser fiber for laryngeal cancer
surgery. Ann Otol Rhinol Laryngol,
2006. 115(7): p. 535-41.
Zeitels, S.M., Anderson, R. R.,
Hillman, R. E., Burns, J. A.,
Experience with office-based
pulsed-dye laser (PDL) treatment.
Ann Otol Rhinol Laryngol, 2007.
116(4): p. 317-8.
Zeitels, S.M., Akst, L., Burns, J. A.,
Office Based Laryngeal Laser
Surgery With the 532nm PulsedPotassium-titanyl-Phosphate Laser.
Current Opinion in Otolaryngology
& Head & Neck Surgery, 2007. 15:
p. 394-400.
Zeitels, S.M. and J.A. Burns, Officebased laryngeal laser surgery with
local anesthesia. Curr Opin
Otolaryngol Head Neck Surg, 2007.
15(3): p. 141-7.
Broadhurst, M.S., Kobler, J.B.,
Burns, J. A., Akst, L., Zeitels, S. M.,
37.
38.
39.
40.
41.
42.
Chick Chorioallantoic Membrane
(CAM) As A Model To Simulate
Human True Vocal Folds. Annals of
Otology, Rhinology & Laryngology,
2007. 116: p. 917-921.
Broadhurst, M.S., Akst, L. M.,
Burns, J. A., Kobler, J. B., Heaton,
J. T., Anderson, R. R., Zeitels, S.
M., Effects of 532 nm pulsed-KTP
laser parameters on vessel ablation
in the avian chorioallantoic
membrane: implications for vocal
fold mucosa. Laryngoscope, 2007.
117(2): p. 220-5.
Burns, J.A., Friedman, A. D., Lutch,
M. J., Hillman, R. E., Zeitels, S. M.,
Value and utility of 532 nanometre
pulsed potassium-titanyl-phosphate
laser in endoscopic laryngeal
surgery. J Laryngol Otol, 2010.
124(4): p. 407-11.
Weinstein, G.S., O'Malley, B. W.,
Jr., Snyder, W., Hockstein, N. G.,
Transoral robotic surgery:
supraglottic partial laryngectomy.
Ann Otol Rhinol Laryngol, 2007.
116(1): p. 19-23.
Zeitels, S.M., Blitzer, A., Hillman,
R.E., Anderson, R.R., Foresight in
Laryngology and Laryngeal
Surgery: A 2020 Vision. Ann Otol
Rhinol Laryngol, 2007. 116
(Supplement 198): p. 1-16.
Karajanagi, S.S., et al., Assessment
of canine vocal fold function after
injection of a new biomaterial
designed to treat phonatory mucosal
scarring. Ann Otol Rhinol
Laryngol, 2011. 120(3): p. 175-84.
Zeitels, S.M., Lopez-Guerra, G.,
Burns, J. A., Lutch, M., Friedman,
A. M., Hillman, R. E.,
Microlaryngoscopic and officebased injection of bevacizumab
(Avastin) to enhance 532-nm pulsed
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45
INTRODUCTION OF THE THIRTY-SEVENTH
DANIEL C. BAKER, JR. MEMORIAL LECTURER
CLARENCE T. SASAKI, MD
ANDREW BLITZER, MD, DDS
The Daniel C. Baker, Jr. Lectureship
was established in 1975 by the Baker
Family, and Dr Baker’s friends, patients and
colleagues, in his memory and in
appreciation for his dedication to the field of
Laryngology. Dr Baker was President of the
ALA in 1974 and a recipient of the
Newcomb Award in 1971.
Dr. Sasaki , born in Honolulu, was a
Phi Beta Kappa graduate of Pamona College
in California, and a prize winning graduate
of Yale University Medical School. His
surgical training was at UCSF and
Dartmouth Med Ctr. He also served as a
military surgeon including a tour of war
duty in Vietnam. He then trained in
Otolaryngology under John Kirchner at the
Yale-New Haven Medical Center where he
has been since that time, now Professor and
Chief of the Section of Otolaryngology. He
also did 3 fellowships under the tutelage of
Ettore Bocca, Hugo Fisch, and Mr. Dai
Davies in London.
He has received many awards for
his careful and dedicated teaching and
research, including The Edmund Prince
Fowler Award for his Triological thesis in
1979; The Casselberry Award from
American Laryngological Association; The
Broyles-Maloney Award from the ABEA;
Guest of Honor of the ALA in 2008; and
the Chevalier Jackson Lecturer of the ABEA
in 2009. He serves on 11 editorial boards of
medical journals. He has been the recipient
of numerous NIH and other research grants
and has served on a number of study
sections for grant reviews. Dr. Sasaki was
taught about the airway and airway
physiology and disease by his mentor John
Kirchner, but then took this knowledge to a
whole new level. He has investigated in a
meticulous fashion and taught all of us how
the larynx and airway work, and how to
attempt to fix it when it is not functioning
well. He has published 218 original articles;
13 case reports; 70 book chapters; and 8
textbooks. Clarence is the consummate
surgeon, scientist, teacher, compassionate
physician, and most of all a friend.
46
THIRTY-SEVENTH DANIEL C. BAKER, JR. MEMORIAL
LECTURE
“The Animal Spirits: A Curse on the Vagus Nerve”
CLARENCE T. SASAKI, MD
New Haven, Connecticut
First of all, I never dreamed that I’d be up
here someday delivering such an important
address. As I sat at home thinking about the
importance of it all, I asked myself “What
would Daniel Baker have to say if he were
here in twenty eleven?” Well, here is my
version of what he might have done.
As you may know, Dr. Baker served as
Chair of Otolaryngology at Columbia
Presbyterian for 10 years in the
1970’s…………And by the way, I am
indebted to both Lanny Close and Jon Aviv
for furnishing me his portrait and bio sketch.
As you may also know, the mystery of the
vagus nerve has been a central focus of my
professional career for many years……and
you may very well have heard my
discussion of it in some form before. I am
hopeful however that the contained message
might be consistent with the thoughts of Dr.
Daniel Baker had he the opportunity to
complete his ALA Presidency, cut short by
his untimely death in 1974.
In that regard, I have chosen to explore the
vagus nerve and its evolving relationship to
the animal spirits. I will start with a little
history of animal spirit-dom, give you a few
concrete examples and conclude with a
message
governing
our
continued
relationship with those very spirits.
And so as our story unfolds, before the dawn of
civilization, ancient man recognized, among
other things, that certain cervical injuries,
including high double vagotomy, invariably
produced a lethal effect. Then, it was not
uncommon for primitive man to invoke
supernatural forces to account for events in the
world he experienced. Natural events, such as
storms with their lightning and thunder, deadly
attacks by wild animals, and the unpredictable
and often turbulent behavior of man himself
were powers anthropomorphized through the
action of spirits, so characterizing all that was
either ambiguous or uncertain in the world
surrounding.
So back to the vagus. Not surprisingly, history
would tell us that Alexandrian physicians in the
47
Baker Lecture
third century B.C. invoked a theory of
animal spirits to explain the uncertain
actions of nerves. According to theory,
animal spirits were thought to be
weightless, invisible entities that flowed
through hollow nerves to globally mediate
bodily functions, such as limb withdrawal,
for example, when contacting heat of a
flame or one’s changing heartbeat, sleep
and awake states, including the lethal
effects of bilateral vagal injury.
In the second century A.D. the animal
spirits theory was further popularized by
the Roman physician Claudius Galen,
whose teachings would indelibly dominate
our understanding of the nervous system
for the next 1,500 years. So you see, Galen
believed that nutrients were absorbed by
the liver, which then produced “natural
spirits”. Such spirits were transported to
the heart which transformed them into
“vital spirits” which were then carried to
the brain to undergo further transformation
into so called “animal spirits”. Such spirits
were thought to reside in the cerebral
ventricles until needed.
Transporting
animal spirits through the hollow nerves
would force muscles into action…..or so
the tale went.
For centuries Galen’s doctrine so dominated
western culture as if the spirits themselves
had taken on an indelible life of their own.
When the Belgian anatomist Andreas
Vesalius published De Humani Corporis
Fabrica in 1543, daring to dispute
fundamental Galenic theory, he was branded
a heretic and forced to flee to Jerusalem.
While even 100 years later, Rene Descartes
nevertheless continued to embrace animal
spirits in celebrating his new foundation for
the biological study of behavior. He would
explain that when one is awake animal
spirits flowed into the brain causing it to
distend while sleep had the opposite effect
resulting in shrinkage as animal spirits
flowed from it to enter nerves distally.
When did all of this fantasy end, you may
ask?
It was not until Luigi Galvani, while sitting
in his kitchen, watching his wife preparing
frog leg soup, that he observed contractions
of the leg muscles of the frog whenever
nerves were contacted by his wife’s kitchen
shears. He observed unequivocally that
animal spirits originating in the brain were
in fact not required for muscle contraction,
since his wife by now had already deftly
separated her frogs’ legs from their bodily
attachments. Galvani’s conclusions shook
the scientific world, but would his
observations and later elegant experiments
dispel the curse of Galen?
Was the
exorcism indeed complete?
Since then, we have been blessed by so
many observational advances in our quest to
better understand the behavior of nerves.
During the last half of the 20th Century, two
fundamental properties of nerves were
established that changed our collective
outlook forever: firstly, the ionic nature of
the propagated action potential and secondly
the process of axonal transport. By means
of a transport mechanism, essential
metabolic components synthesized in the
nerve cell bodies could be carried through
the relatively long length of nerve fibers to
preserve and maintain the viability and
function of ion channels and pumps.
Axonal flow, seen spilling out at the cut end
of this nerve, also provided for the metabolic
needs of specialized receptor terminals and
the formation of neurotransmitters. These
advances, not the fanciful animal spirits of
Galen or Descartes, have come to represent
the
fundamental
cornerstones
for
understanding modern neuroscience and for
the rational interpretation of neuropathies
and eventually their therapy.
So back to the vagus. This nerve, derived
from the Latin to wander, is composed of
48
Baker Lecture
sensory and motor fibers exhibiting a more
extensive anatomic course and distribution
than any other cranial nerve as it wanders
through the neck and thorax to the abdomen.
Its branches project to the external ear,
carotid body, laryngopharynx, esophagus,
heart, lungs, stomach and other abdominal
viscera. As you know, multiple cross
interactions among somatic and visceral
vagal functions are commonplace in states
of both health and disease.
As we are a society of Laryngologists then,
let me provide you a few examples of how
systematically derived observations, based
on a rich history of physiologic principles,
have enhanced our understanding of the
vagus nerve in health and ultimately
modified our management of certain
diseases, animal spirits, of course,
notwithstanding. Within the constraints of
time, I will present to you several interesting
observations you may not fully know about,
yet each of them dispelling common legend.
Firstly, a two-year-old boy presents to the
emergency room with a barking cough,
stridor, and fever.
His concerned
pediatrician
directs
the
emergency
department to place the boy into a cold mist
tent to loosen mucus plugs that are
responsible
for
increasing
airway
turbulence.
The E.R. doc shrugs his
shoulder in disbelief but complies. Within
20 minutes, work of breathing has eased and
all are relieved. Did we loosen secretions or
did we selectively stimulate the vagus to
render a beneficial outcome?
If one stimulates the superior laryngeal
nerve of the vagus by delivering a micro
aerosol of water, particle size 6.5 micron, to
the supraglottic larynx while measuring
phasic bursts of inspiratory activity from the
phrenic nerve, a couple of measures are
notable. By comparing the upper pair of
traces to the lower, the rate of breathing
slows 38% from baseline. If we integrate
the phrenic EMG signal (seen in the lower
traces of each pair), upward slope of the
inspiratory phase correlates with tracheal
airflow and what do we find? Micro aerosol
stimulation of the supraglottic vagus not
only slows breathing rate but also decreases
tracheal airflow by 47%, clearly benefiting
our patient with airway obstruction due to
turbulent airflow of croup.
This interesting response, however, is
blocked if one topically anesthetizes the
larynx with 2% tetracaine, the bottom pair of
traces showing no measureable difference
over baseline above. Selectively stimulating
the tracheobronchial mucosa distal to the
larynx, on the other hand, also produces no
measurable change over baseline.
So, our ability to selectively stimulate
vagally mediated supraglottic mucosal
receptors with aerosolized water
suggests that the larynx, at times itself,
serves as a sensory organ in respiratory
control. By the way, stimulating with water
or saline micro aerosol produces identical
results. The likely vagal receptors involved
are therefore supraglottic mechanoreceptors
rather than specialized mucosal chemoreceptors, dispelling, once and for all, the
implausible legend of mucous plugs in viral
croup.
Another example. An established surgeon, a
veteran of many years’ experience, removes
a laryngocoele but inadvertently injures the
internal branch of the superior laryngeal
nerve. Knowledge that this damaged branch
of the vagus is purely sensory, reassures him
that his patient will suffer no serious
consequence.
Shortly thereafter, when his patient
experiences multiple aspiration events, she
is told that unilateral deafferentation may
produce a small sensory field defect that will
eventually rectify itself. Is our surgeon
entirely correct? Is there any help around
the corner?
49
Baker Lecture
By creating a model of unilateral superior
laryngeal nerve section, we measured glottic
closing force by dropping a pressure
transducer between the cords as we
electrically stimulated the superior laryngeal
nerves. In a control intact model, the mean
glottic closing force measures 276 mm Hg.
After unilateral superior laryngeal section,
glottic closing force unexpectedly drops to
149 mm Hg. Expressed as percentage
reduction, if control closing force is
represented as 100%, closing force after
superior nerve section drops to as much as
54% of control………clearly……creating a
much weaker response.
The following explanation may be helpful.
Each superior laryngeal projects to its
ipsilateral
and
contralateral
nucleus
ambiguus through its ipsilateral solitary
nucleus. This results in the combined
simultaneous activation of motor neurons
not only on the same side, but also on the
other. In this organizational model, injury to
one superior nerve, while preserving
bilateral reflex cord adduction, takes out
almost half of the combined adductor
neurons. In other words, four motor neurons
are reduced to two! The resultant 50%
reduction in active neurons supports a
calculable reduction in glottic closing force,
perhaps the cause of repeated aspiration
events in our patients.
But, is there help around the corner?
We
are
also
aware
that
medialization thyroplasty carries the
capability of restoring up to 57% of glottic
closing force and indeed such a procedure
greatly reduces our patient’s aspiration
events without altering voice quality.
In this, there is an unexpected lesson that
could not have been predicted by Grey’s
Anatomy alone.
Dispelling another legend, unilateral
sensory denervation contributes to aspiration
by means other than simply creating a
sensory field defect.
Rather, superior
laryngeal injury actually reduces the force of
reflex glottic closure to 50% of control, a
fact that can be remediated by, of all things,
medialization thyroplasty.
Bear with me for another quick example. In
the middle of the night, a 4-year-old is
emergently evaluated for a foreign body and
stridor. She is emergently tracheotomized
by the hospital’s ENT resident, saving her
life, while removing a foreign body lodged
in the vallecula. Weeks later, unable to
successfully decannulate the patient, her
PCP questions whether collateral injury by
the resident is responsible for the worrisome
inspiratory stridor experienced by abrupt
removal of the trach tube.
A series of observations concerning vagal
modulation of phasic vocal cord abduction
may shed light on a potentially thorny
confrontation. In fact, much of our patient’s
response to tracheotomy is governed by
vagally mediated control of respiration. If
we monitor the phasic EMG activity of
posticus muscle in response to varying
ventilatory load, we will likely derive the
following relevant simple but notable
observations.
During spontaneous nasal breathing when
ventilatory resistance is judged to be
maximal (within physiologic range) seen in
the top pair of traces, spontaneous phasic
posterior cricoarytenoid activity likewise
appears to be maximal corresponding to a
negative inspiratory pressure change of 15
mm of water. Approximately three minutes
following a change to mouth-breathing (with
a drop in ventilatory load), posticus activity
decreases in the trace pair below
corresponding to a decrease in intra-tracheal
pressure change.
When spontaneous
breathing is shunted through a tracheotomy,
abductor activity in the upper trace not only
diminishes but completely ceases, as you
see, resulting in complete electrical silence.
50
Baker Lecture
However, when the tracheotomy is partially
occluded and ventilatory load partially reestablished, posticus activity slowly
recovers as seen in the lower trace. Now,
approximately four weeks following
tracheotomy, partial trach tube occlusion
produces no measurable return of phasic
posticus activity.
In the lower trace,
complete trach tube occlusion at this time
induces severe laryngeal inspiratory stridor
and cyanosis due to physiologic abductor
failure.
However, daily incremental
reestablishment
of
ventilatory
load
successfully reestablishes phasic abductor
activity and in this case favoring successful
decannulation.
And so, back to the story of the resident and
his patient.
All are relieved and a
potentially
thorny
misunderstanding
successfully dispelled. The parents and PCP
are again happy and satisfied and our ENT
resident has learned a valuable lesson in
vagal control of laryngeal respiratory
function. In fact, he goes on to spend much
of his career attempting to unravel the
mysteries of the vagus nerve in
Otolaryngology, even receiving the privilege
of delivering today’s Baker Lecture.
I could go on with other tales of fascination
with the vagus nerve, had I more time. But
now allow me to return to the focus of this
lecture.
These kinds of observations, arguably
simple and rudimentary, don’t always come
easily. First of all, they are observations of
clinicians, like these, not basic scientists,
and they are made by clinicians who
generally reflect a fond appreciation for
historical
advances
shaped
by
neurophysiologic principles of discovery.
Let me to leave you then with two messages.
Firstly, it is true we (that is, our collective
membership here) have been responsible for
many such advances in understanding the
vagal control of breathing, swallowing, and
speaking. Further advances will ultimately
rest upon continued discovery at the hands
of clinicians like you. Why, you may ask? I
can tell you from many years of NIH
interaction, basic scientists working alone
will never enter this field in significant
strengths and for good reason. Research
methods most effective in the discovery of
experimental principles of vagally mediated
functions are necessarily physiologic, not
molecular and are therefore less attractive to
current biological sciences.
But perhaps more importantly, basic
scientists are understandably uniformed of
clinical questions that arise from daily
interaction with our patients.
Major
advances have therefore always been and
will likely continue to be the product of
super-clinicians like Sir Victor Negus, Sir
Donald Harrison, Joe Ogura and John
Kirchner to name a few from our past, each
of them having done his part to dispel the
curse of animal spirits. So you, my fellow
clinicians, are the future of discovery. And,
understanding the vagus is key to detection,
prevention, and cure of throat disease.
And, now finally back to animal spirits. We
all do recognize that systematic discovery is
often a slow and caretaking process.
Alternatively, it is so tempting for us, like
primitive man, to invoke the spirit of
neurophysiologic terms and principles to
explain ambiguous or uncertain clinical
events without adequately testing them, or
more concerning, using them to justify
therapeutic interventions based on untested
beliefs.
What I am trying to say is that today we
struggle with animal spirits of a very
different shape and color. You have heard
at meetings of this kind, terms loosely
applied to the vagus such as, aberrant
regeneration, synkinesis, paresis, inhibition,
even words like sensory collision, all
neurophysiologic terms that sound very,
51
Baker Lecture
very convincing but if poorly tested sound
as much like Galen’s animal spirits to
civilized man 2000 years ago.
Has the curse of today’s animal spirits been
dispelled once and for all?
Was the
exorcism of the 1700’s truly complete?
Only if we continue to reasonably apply
those principles of inquiry defined by
scientific process, testing and re-testing each
hypothesis until we render them bulletproof.
If we don’t, there of course will be no
federal bailout. Laryngology is not exactly
the City Group or AIG of American
medicine. We are NOT too big to fail and
there will be no NIH rescue.
As primitive man breathed life into animal
spirits to explain the unknown and as our
scientific forefathers revived those very
spirits to raise the level of interest and
credibility in the study of neural behavior, so
do we occasionally retreat to embrace those
animal spirits whenever confronted with the
questionable behavior of the vagus nerve.
For all those residents and fellows joining us
from the tops of their graduating classes,
beware of today’s animal spirits, those
fancy-sounding terms drawn from man’s
primeval instincts and loosely applied to
events not well understood. By virtue of our
position in American Medicine, you are
armed with the talent and tools to detect,
neutralize, and dispel the curse of those
spirits wherever it should appear.
52
SCIENTIFIC SESSIONS
The Effect of Temporary Vocal Fold Injection Medialization Laryngoplasty on the Rate of
Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis Patients
Katherine C. Yung, MD; Ilya Likhterov, MD; Mark S. Courey, MD
Initial treatments for unilateral vocal fold paralysis include observation, voice therapy, or
temporary vocal fold injection medialization. If the vocal fold function and voice do not
spontaneously improve, permanent medialization is often performed in a delayed manner. The
aim of this retrospective chart-review was to determine the effect of temporary vocal fold
injection medialization on the rate of permanent medialization laryngoplasty. Demographic
information, etiology of paralysis, and treatment information was obtained on 51 eligible patients.
Patients were divided into 2 groups based on their election for temporary injection. Demographic
information and etiology were similar between the groups. Thirty-five percent (6/17) of patients,
who underwent temporary injection, elected for subsequent delayed permanent medialization. In
comparison, 61.8% (21/34) of patients treated with observation elected for delayed permanent
medialization. This trend suggests that temporary injection medialization reduces the likelihood
of patients electing for a permanent intervention. Further study is warranted and ongoing.
Activity Dependent Electrical Stimulation of a Denervated Laryngeal Muscle Can
Prevent Synkinetic Reinnervation and Restores Function
David L. Zealear, PhD; Kenichiro Nomura, MD, PhD
Isamu Kunibe, MD, PhD; Akihiro Katada, MD, PhD
Yike Li, MD; Rajshri Mainthia, BS
Cheryl Billante, PhD
A clinical model of laryngeal paralysis was studied in the chronic canine where both
laryngeal nerves were sectioned and ventilation compromised. The PCA muscles were implanted
with electrodes leading to a pulse generator. Animals were randomly assigned to 3 groups to
assess the effect of different stimulus paradigms on reinnervation quality and degree of functional
recovery. Spontaneous vocal fold movement was measured endoscopically. Exercise tolerance
was measured on a treadmill. EMG potentials were recorded from abductor muscles and adductor
muscles during hypercapnic respiration to index reinnervation by inspiratory motoneurons, and
during SLN stimulation to index reinnervation by adductor motoneurons. Nonstimulated controls
and stimulated 40 pps animals showed paradoxical closure of the glottis during hypercapnea and
decreased exercise tolerance due to faulty reinnervation. In contrast, stimulated 10 pps animals
showed no paradoxical closure during hypercapnea and normal exercise tolerance. EMG findings
demonstrated significantly less faulty reinnervation by foreign adductory motoneurons.
53
Scientific Sessions
A Cost Analysis of True Vocal Fold Paralysis Secondary to Thyroidectomy
Philip Weissbrod, MD; Michael Pitman, MD
Objectives: To determine the cost to the national economy of the treatment of recurrent
laryngeal nerve paralysis related to thyroidectomy. To provide a cost effective treatment
algorithm that maximizes patient outcome and minimizes morbidity.
Methods: Cost analysis based on Medicare fees for the treatment of vocal fold paralysis
related to thyroidectomy. Cost analysis of primary nerve repair with ANSA cervicalis, injection
laryngoplasty, electromyography, type 1 laryngoplasty and lost worker productivity. When
applicable, cost of office versus operating room procedures is incorporated.
Results: Traditional methods of management result in costs of $19,469.71 per person.
When transection is recognized intraoperatively, optimal treatment costs $2,834.34. When
paralysis is noted postoperatively, optimal treatment costs $11,389.78. When applied to a national
scale, savings can be conservatively estimated at greater than $7.5 million.
Conclusion: Optimal treatment of vocal fold paralysis after recurrent laryngeal nerve
injury minimizes healthcare expenditures, lost worker productivity time, and potential
medicolegal claims while decreasing patient morbidity.
Qualitative and Quantitative Laryngeal Electromyography Predicts
Motion Recovery in Acute Recurrent Laryngeal Neuropathy
Libby J. Smith, DO; Clark A. Rosen, MD
Christian Niyonkuru; Michael C. Munin, MD
Quantitative laryngeal electromyography (LEMG) adds objective information (turns
analysis) regarding extent of neurologic injury. Retrospective review was performed of LEMG
data (quantitative and qualitative) after recurrent laryngeal neuropathy (RLN) in patients with
clinical vocal fold paralysis and varying degrees of motor unit recruitment. Prognosis was
correlated with actual vocal fold motion recovery status (minimum of 6 months following onset)
using positive and negative predictive values (NPV, PPV) in patients undergoing LEMG for
prognosis analysis with acute vocal fold paralysis. 23 patients underwent LEMG for RLN,
including evaluation of recruitment, motor unit configuration, detection of fibrillations,
synkinesis testing, and turns analysis. All 4 patients with excellent LEMG prognosis recovered
motion, while 17/19 patients with fair/poor LEMG prognosis were without motion, resulting in a
100% PPV and 89.5% NPV. Integrating both qualitative and quantitative LEMG data improves
prognostic accuracy in vocal fold paralysis patients who demonstrate voluntary motor unit
activity.
54
Scientific Sessions
Laryngeal Electromyography for Prognosis of Vocal Fold Palsy: A Meta-Analysis
Scott Rickert, MD; Lesley Childs, MD;
Tom Murry, PhD; Lucian Sulica, MD
Purpose: Meta-analysis of Laryngeal electromyography (LEMG) for prognosis in cases
of vocal fold palsy (VFP)
Procedures: Eight studies reporting LEMG results and clinical outcome in 473 cases of
VFP were identified by literature search. Results: 283/473 patients (59.8%) had findings
consistent with axonal injury, while 190/473 (40.2%) had voluntary motor unit potentials size and
recruitment consistent with recovery. According to laryngoscopic examination, 258/283 of
patients with axonal injury had poor recovery (PPV=91.2%) while 25/283 (9.8%) had good
recovery. In patients with findings consistent with recovery, 98/190 (NPV=51.6%) noted good
recovery while 92/190 (48.4%) noted poor recovery. Odds ratio was 10.993 with 95% confidence
interval of 6.69-18.06.
Conclusions: LEMG is a good predictor of poor recovery in patients with VFP and is
clinically useful in identifying candidates for early definitive intervention.
Total Resection of the Cricoid Cartilage with Thyrotracheal Anastomosis in the
Treatment of Low-Grade Chondrosarcoma of the Larynx.
Andrea Gallo, MD, PhD; Marco de Vincentiis, MD
Antonio Greco, MD; Massimo Fusconi, MD
Giulio Pagliuca, MD, PhD; Salvatore Martellucci, MD, PhD
Objective: To describe a partial laryngeal surgical technique for the treatment of
chondroma and low-grade chondrosarcoma of the larynx. These cartilaginous tumours arise
within the endolaryngeal structures, primarily from the cricoid cartilage. These tumours are
generally treated with total laryngectomies which may be considered an overtreatment since they
are low-grade malignancy tumours. A preservative approach would therefore be preferable.
Methods: Three patients with low-grade chondrosarcoma of the larynx underwent total
cricoidectomy. A pexy was performed between the trachea and the residual larynx.
Results: No evidence of tumour recurrence was detected at 3 years of follow-up. One
month after surgery all patients were able to tolerate a soft diet and to speak satisfactorily. One
patient was ultimately decanulated whereas two patients still have a tracheostomy.
Conclusions: Total cricoidectomy may obviate the need for total laryngectomy in low-grade
chondrosarcoma of the larynx.
55
Scientific Sessions
CT-Scan Prediction of Thyroid Cartilage Invasion for Early Laryngeal Squamous
Cell Carcinoma
Dana M. Hartl, MD, PhD; Guillaume Landry, MD
Francois Bidault, MD; Morbize Julieron, MD
Gérard Mamelle, MD; Francois Janot, MD
Daniel F. Brasnu, MD
Treatment for laryngeal cancer may be influenced by preoperative computed tomography
scan (CTs) suspicion of thyroid cartilage invasion. Our aim was to determine its predictive value
for tumors treated with open partial laryngectomy. Retrospective study of tumors treated with
complete or partial resection of thyroid cartilage. CTs were compared to tumor stage, anterior
commissure (AC) involvement, vocal fold (VF) mobility and histopathological thyroid cartilage
invasion. Of 236 tumors cT1 (26 %) cT2 (55 %) cT3 (19 %), histopathological thyroid cartilage
invasion was seen in 8%. CTs sensitivity was 10.5%, specificity 94%, positive predictive value
13%, negative predictive value 92%. In false-positive CTs, AC tumors were over-represented
(61.5% versus 27%, p=.004). Tumors with decreased VF mobility were over-represented in falsenegative CTs (41% versus 13%, p=.004). CTs was not effective in predicting thyroid cartilage
invasion, overestimating cartilage invasion for AC lesions and underestimating invasion for
lesions with decreased VF mobility.
Thyroid Cartilage Invasion in Early-Stage Squamous Cell Carcinoma Involving the
Anterior Commissure
Dana Hartl, MD, PhD; Guillaume Landry, MD
Odile Casiraghi, MD; Patrick Marandas, MD
Francois Janot, MD; Stéphane Hans, MD, PhD
Daniel F. Brasnu, MD
The anterior commissure (AC) poses a particular problem due to the proximity of the
thyroid cartilage to the mucosa. Our objective was to evaluate incidence and the risk factors for
thyroid cartilage invasion in laryngeal cancer involving the AC treated with open conservation
surgery. Retrospective study of tumors involving the AC. Tumor stage, extensions, vocal fold
(VF) mobility, and pathological cartilage status were recorded. 94 tumors staged cT1b (44%),
cT2 (50%), cT3 (6%) were treated using vertical (31%) or supracricoid laryngectomy (69%).
Overall, thyroid cartilage invasion was 8.5%. The incidence of cartilage invasion was higher if
VF mobility was impaired (31% versus 5%, p=.002), but was not related to supraglottic or
subglottic extension, uni- versus bi-cordal lesions, type of surgery or CT scan prediction (P>.05).
VF mobility was the only significant factor related to thyroid cartilage invasion and should be
taken into consideration when planning surgical resection of these tumors.
56
Scientific Sessions
Salvage Surgery for Laryngeal Cancer after Failure of Different
Organ Preservation Strategies
Cesare Piazza, MD; Giorgio Peretti, MD
Francesca Del Bon, MD; Stefano Mangili, MD
Luca Oscar Redaelli De Zinis, MD; Piero Nicolai, MD
INTRODUCTION: Salvage surgery (SS) for persistent/recurrent cancer must act as
parachutes after failures of surgical and non-surgical laryngeal preservation strategies.
MATERIAL AND METHODS: 302 persistent/recurrent laryngeal cancers were treated
by SS between 1986 and 2007. They had been previously submitted to chemoradiotherapy
(CRT/RT) or radiotherapy (Group A), transoral laser surgery (TLS) (Group B), and open neck
partial laryngectomies (ONPL) (Group C). SS encompassed TLS, ONPL, and total laryngectomy
(TL) with/without postoperative RT/CRT.
RESULTS: Five-year overall, determinate survivals, and organ preservation were 69.5%,
75.3%, and 55.5% for Group A, and 89.1%, 93.5%, and 83.8% for Group B+C (p=0.0001 for
every comparison). Major postoperative complications were encountered in 29.3% of patients in
Group A versus 7.1% in Group B+C (p=0.001).
CONCLUSIONS: SS can be accomplished using the same tools of primary treatment
(TLS, ONPL, TL) even though survivals, complications, and organ preservation are significantly
influenced by the previous treatment.
Optical Injector: A Novel Device for Improved Airway Injection
Sanjay Manohar Athavale, MD
Injections of the glottis, subglottis, and trachea are a common procedure used by
laryngologists. Generally, airway injection requires two hands, one manipulating a flexible or
rigid endoscope and the other manipulating an injection instrument. Due to the constraints of
limited visibility, mobility, and time, airway injections can be cumbersome. Therefore, there is a
need for a faster and more efficacious means of injecting the airway. A novel device has been
created that allows for an injection device to be incorporated with an endoscope, thereby allowing
for steady, consistent injections with a single hand. The device has been tested on surgeons of
different experience levels and preliminary results show increased speed and efficacy of
injections. Additionally, it allows the operator to have a free hand to manipulate a second
instrument. With continued modifications and testing, we hope this device will be able to enhance
and improve airway injection therapy.
57
Scientific Sessions
A Multi-Institutional Analysis of Tracheotomy Complications
Stacey Halum, MD; Gregory Postma, MD
Nicole Maronian, MD; John Sinacori, MD
Michael Pitman, MD; Sid Khosla, MD
Dale Ekbom, MD; Albert Merati, MD
Objectives: This multi-institutional hospital-level study aimed to provide detailed
information about the factors associated with tracheotomy intra-operative and post-operative
complications.
Methods: Eight academic institutions contributed. Data was collected on consecutive
tracheotomy procedures at each institution, with patient comorbidities, surgeon, technique,
postoperative management, early complications (within first week), late complications (beyond
first week), and outcomes recorded.
Results: Detailed information on over 1100 tracheotomy procedures was obtained from
eight academic institutions. Otolaryngologists performed 68% of the tracheotomies. There were
significant differences in preferred technique at different institutions. Early and late complication
rates were 9% and 12%, respectively. Certain intraoperative and perioperative management
factors were identified that were associated with increased complication rates.
Conclusion: This study identified specific hospital-level management factors associated
with increased complications. Findings, in conjunction with national-level database information,
will be important in establishing evidence-based guidelines.
Partial Posterior Cricoid Plate Removal for Wide Interarytenoid Distance
Nicolas Maragos, MD
The open posterior glottis may affect voice and swallow. Procedures used to improve
posterior glottic closure include arytenoid adduction and arytenoid fixation (adduction
arytenopexy). When the interarytenoid distance is great and other procedures fail, removal of a
vertical strip of posterior cricoid plate may be beneficial. We identified nine patients between
March, 2006 and August, 2010 with an abnormally wide interarytenoid distance. Etiologies
included cricoarytenoid joint fixation, laryngeal/neck/head trauma, and congenital abnormality.
Surgical approach includes tracheostomy, thyrotomy, removal of a vertical strip of posterior
cricoid plate, bilateral disruption of the cricothyroid joints, and cricoid stabilization with an
external titanium plate. All patients self-decannulated within 3-6 weeks post-op with voices
stronger and easier to produce after healing. Partial posterior cricoid plate removal is offered for
improving posterior glottic closure in patients’ recalcitrant to other surgical options.
58
Scientific Sessions
Voice Outcomes Following Adult Cricotracheal Resection
Jeffrey J. Houlton, MD; Alessandro de Alarcon, MD
Kalaan Johnson, MD; Jareen Meinzen-Derr, PhD, MPH
Susan Baker-Brehm, PhD, CCC-SLP; Barbara Weinrich, PhD, CCC-SLP
Ravindhra G. Elluru, MD, PhD
Introduction: Cricotracheal resection (CTR) is an effective treatment for moderate-tosevere laryngotracheal stenosis (LTS) in adults. However, voice outcomes following this
procedure have rarely been reported.
Methods: Acoustic, aerodynamic, stroboscopic, and Consensus Auditory-Perceptual
Evaluation of Voice (CAPE-V) data were reviewed for consecutive adult patients following CTR
between 2000-2010.
Results: Thirteen patients (median age 43 years, 85% female) underwent postoperative evaluation
and had a mean overall CAPE-V score of 52/100, mean fundamental frequency (F0) of 156.7Hz,
estimated subglottic pressure of 8.3kPa, and an average airflow of 213Liters/minute. Six patients
underwent pre- and postoperative evaluations and had a significant reduction in F0
(205.3vs.157.7, p=0.03), but not in median intensity, range, pressure, or flow. Overall CAPE-V
scores worsened, but did not reach statistical significance (14vs.59, p=0.25).
Conclusions: Although CTR is an effective treatment for adult LTS, the current study
indicates that CTR has significant ramifications on voice outcome. Patients should be counseled
about these potential voice alterations preoperatively.
Raised Intensity Phonation Compromises Vocal Fold Epithelial Barrier Integrity
Bernard Rousseau, PhD, CCC-SLP; Atsushi Suehiro, MD, PhD
Nicholas Echemendia, BS; Mahalakshmi Sivasankar, PhD
We investigated the hypothesis that 30-minutes of raised intensity phonation alters
transcript levels of vocal fold intercellular tight junction (TJ) proteins and disrupts the epithelial
barrier. Eighteen New-Zealand-White rabbits were randomly assigned to receive 30-minutes of
raised intensity phonation or vocal fold approximation without phonation. Quantitative
polymerase chain reaction was used to investigate transcript levels of the TJ proteins, occludin
and zonula occludin-1 (Z0-1), and the adherens junction proteins β-catenin and E-cadherin.
Structural alterations to the epithelium were further examined by scanning electron microscopy
(SEM) and transmission electron microscopy (TEM). Mann-Whitney U revealed significantly
decreased occludin (P = .016) and β-catenin (P = .016) from rabbits undergoing raised intensity
phonation, compared to control. There were no significant differences in Z0-1 and E-Cadherin (P
>.025). SEM revealed significant obliteration, desquamation, and evidence of microhole
formation in vocal folds exposed to raised intensity phonation, while TEM revealed dilated
intercellular morphology between groups
59
Scientific Sessions
Regeneration of Aged Vocal Folds with Basic Fibroblast Growth Factor: Results of
Clinical Trial
Shigeru Hirano, MD; Ichiro Tateya, MD, PhD
Yo Kishimoto, MD; Satoshi Ohno, MD
Tsuyoshi Kojima, MD; Shin-ichi Kanemaru, MD
Objectives: Aged vocal fold is characterized by atrophy of the mucosa which causes
glottal insufficiency. The present clinical trial examined regenerative effects of basic fibroblast
growth factor (bFGF) on restoration of aged vocal folds.
Methods: Ten patients (6 men and 4 women, mean age of 70.1 years) were recruited in
the trial. Ten microgram of bFGF was injected into one vocal fold. Injection was performed
unilaterally or bilaterally accordingly, and repeated if necessary up to 7 times. The patients were
followed up at least for 6 months. The effects were assessed by acoustic and aerodynamic
measurements.
Results: All patients showed improvement of voice. Maximum phonation time, mean
flow rate, jitter, and noise-to-harmonic ratio indicated significant improvement up to 1year,
although shimmer did not reach to significant improvement point.
Conclusion: The clinical trial demonstrated that bFGF has a significant role in
regenerative effects for aged vocal folds.
Glucocorticoids and the Vocal Fold Mucosa
Ryan C. Branski, PhD; Hang Zhou, MD, MS
Mahalakshmi Sivasankar, PhD; Milan Amin, MD;
Dennis H. Kraus, MD
Introduction-Office-based procedures are increasingly common. The utility and efficacy
of glucocorticoid (GC) injections have been reported for a variety of conditions. We seek to
provide mechanistic insight into GC activity in the vocal folds.
Procedures- The presence/density of the GC receptor in the rat vocal fold was determined
immunohistochemically. Human vocal fold fibroblasts were also treated with dexamethasone
(DM), with emphasis on ECM metabolism.
Results- The GC receptor is densely distributed in the vocal fold epithelium and capillary
walls, with diffuse staining in the lamina propria. Fibroblast expression of the GC receptor
decreased as function of increased DM. DM decreased fibroblast proliferation and collagen
synthesis. DM also appears to modulate collagen metabolism via regulation of MMP and TIMP
secretion.
Conclusions-These data provide preliminary mechanistic insight into this evolving
treatment modality, suggesting that steroids have significant matrix-based effects, beyond the
expected anti-inflammatory actions.
60
Scientific Sessions
Western Blot Confirmation of the H+/K+-Atpase Proton Pump in the Human
Larynx and Submandibular Gland
Kenneth W. Altman, MD, PhD
Yayoi Kinoshita, DMD; Melin Tan-Geller, MD
David Burstein, MD; James A. Radosevich, PhD
Purpose: We previously demonstrated the H+/K+-ATPase (proton pump) in human
larynx and lung glands via immunohistochemistry (IHC). The present hypothesis is that the
proton pump exists in other seromucinous glands, and confirms IHC findings with western blot
analysis.
Methods: Fresh human tissue comprised 3 submandibular glands, 4 larynges, and 3
normal stomach controls. Submandibular gland was immunostained with two monoclonal
antibodies selectively reactive with alpha or beta subunits. Western blot analysis was performed
on all specimens.
Results: The submandibular gland revealed positive IHC for alpha and beta subunits.
Western blot for the 100kDa alpha protein was present for all larynx and submandibular gland
specimens. The 60-80 kDa glycosylated beta subunit protein, and the 52 kDa precursor were also
present for all specimens.
Conclusion: This presence may play an important role in acid-base balance of tissue
exposed to laryngopharyngeal reflux (LPR), and be a potential target for proton pump inhibitor
pharmacotherapy.
Sendai Virus-Mediated Transgene Expression in the Larynx
Daisuke Mizokami, MD; Nobuaki Tanaka, MD
Hiroshi Suzuki, MD; Makoto Inque, PhD
Mamoru Hasegawa, PhD; Akihiro Shoitani, MD
Koji Araki, MD, PhD
Introduction: The potential for gene therapy to be an effective treatment for laryngeal
impairments has been hampered by the genotoxic potential of current viral vectors. Sendai virus
(SeV) vector is expected to be safer than DNA viral vectors like adenovirus, because SeV is an
RNA virus, of which the transfected genome is located exclusively in the cytoplasm and does not
go through a DNA phase. In addition, the high gene expressions have been noticed in many
tissues including the airway epithelial, muscle, inner ear and neural tissues.
Methods: GFP expression was evaluated after direct aerosolized administration of the
recombinant SeV vector expressing GFP into the rat larynx.
Results: Efficient GFP expression was observed not only in vocal cord epithelium but
also in Reinke's space.
Conclusions: SeV is a useful and convenient vector which has potentials to be a
promising strategy for gene therapy for laryngeal impairment
61
Scientific Sessions
Bioengineered Prosthesis with Fibroblasts for Cricoid Regeneration
Yukio Nomoto, MD; Wataru Okano, MD
Mituyoshi Imaizumi, MD; Akiko Tani, MD
Mika Nomoto, MD; Koichi Omori, MD
Introduction: Our group reported an artificial prosthesis for airway reconstruction. This
prosthesis was applied to human cases, and postoperative courses were almost satisfactory except
that it took two months for the prosthesis to be covered by epithelium. Our group reported that a
bioengineered prosthesis with fibroblasts was effective in rapid regeneration of trachea in rat and
rabbit model. The purpose of this study is to evaluate effects of the bioengineered prosthesis on
regeneration of larynx.
Procedures: Collagenous solution with rat dermal fibroblasts was infiltrated into the piece
of the prosthesis and gelatinized. The piece of bioengineered prosthesis was implanted into
cricoid defects of rats.
Results: After reconstruction, epithelial and subepithelial regeneration of cricoid defects
with bioengineered prosthesis were more rapid than that with artificial prosthesis only.
Conclusions: It was suggested that bioengineered prosthesis with fibroblasts was
effective in rapid regeneration of larynx.
Cervical Variation of the Phrenic Nerve
Adam DeConde, MD; H. Wayne Lambert, PhD
Sean Dodson, BS; Blake Daney, BA
Elena Stark, MD, PhD; Gerald S. Berke, MD
Jonathan J. Wisco, PhD; Abie Mendelsohn, MD
Objectives: Reinnervation of the posterior cricoarytenoid muscle with a phrenic nerve
(PN) root has been shown to restore physiologic motion in animal models. Translation to humans
is limited by the knowledge of PN anatomy.
Methods: Dissection of 112 cadaveric necks (89 embalmed and 23 fresh).
Results: Length of fresh cadaver C3, C4, and C5 nerve roots was 3.9 +/- 2.4, 3.6 +/- 2.6,
0.5 +/- 0.8 cm, respectively. Embalmed cadavers had shorter C3 and C4 PN root lengths than
unembalmed cadavers (p = 0.02 and p = 0.03, respectively). Nine PN root patterns were
identified. The most common pattern was single C3/C4 contributions with an immeasurable C5,
present in 30/112 (27%). 25/112 (22%) demonstrated single C3/C4/C5 contributions.
Conclusions: There is wide variability within the anatomy of the PN. Additional study is
required to identify predictive factors for viable donor nerves in cases of bilateral vocal cord
paralysis and laryngeal transplantation.
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Scientific Sessions
High-Speed Videoendoscopic Analysis of Relationships between Cepstral-Based
Acoustic Measures and Voice Production Mechanisms in Patients Undergoing
Phonomicrosurgery
Daryush D. Mehta, PhD; Steven M. Zeitels, MD
James A. Burns, MD; Aaron D. Friedman, MD
Dimitar D. Deliyski, PhD; Robert E. Hillman, PhD; Susan Thibeault, PhD
There is increased interest in using cepstral-based acoustic measures for objective clinical voice
assessment because of apparent advantages over more time-honored methods, but there is a
paucity of information about how these newer measures relate to underlying phonatory
mechanisms. Relationships between the cepstral peak prominence (CPP) and high-speed
videoendoscopy (HSV)–based measures of vocal fold phonatory function were investigated in 20
subjects who underwent phonomicrosurgery for vocal fold lesions. Results based on changes in
measures between pre-surgical and post-surgical assessments showed that CPP correlated
significantly with an HSV-based measure combining fundamental frequency deviation and speed
quotient (r = –0.70, p < 0.001) and that variation in CPP could also be attributed to trading
relationships between HSV-based measures of vibratory phase asymmetry and glottal closure.
These initial results demonstrate that the clinical utility of cepstral-based measures can be
enhanced by a better understanding of how these measures relate to underlying phonatory
mechanisms.
Genetic Characterization of Pre-Malignant and Malignant Vocal Fold Lesions
Rebecca S. Bartlett, MA; W. Wesley Heckman, MD
Jason Isenberg, MD; Susan Thibeault, PhD; Seth H. Dailey, MD
Malignant transformation of laryngeal keratosis has been reported in 1-40% of patients
(1-2), yet reliable criteria for predicting patients most at risk have yet to be determined.
Diagnoses are traditionally made clinically and with histopathology, and errors in biopsy
sampling and interpretation are common. In an effort to elucidate genetic markers distinguishing
premalignancy from malignancy, we used qPCR to compare expression of 84 cancer pathway
genes of patients histologically diagnosed with nondysplastic epithelium with keratosis (ND=7),
keratotic dysplasia (DY=3), and invasive carcinoma (CA=7). All patients had a clinical diagnosis
of leukoplakia and/or erythroplakia, and biopsies were obtained from true vocal fold tissue.
Expression of matrix metalloproteinases (MMP1, MMP2, MMP9) were found to statistically
differentiate the groups (p<.01), suggestive of a critical pathway for extracellular matrix
degradation in laryngeal oncogenesis. These preliminary data represent genetic expression
markers with the potential to stratify patients into prognostic categories, and ultimately guide
treatment. REFERENCES 1. Bouquot JE, Gnepp DR. Laryngeal precancer: a review of the
literature, commentary, and comparison with oral leukoplakia. Head Neck. 1991; 13(6):488-97. 2.
Silamniku B, Bauer W, Painter C, Sessions D. The Transformation of laryngeal keratosis into
invasive carcinoma. Am J Otolaryngol. 1989; 10(1):42-54
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Scientific Sessions
Laryngeal Dysplasia: Role of Human Papillomavirus in Nonsmokers
Andrea Gallo, MD, PhD; Giulio Pagliuca, MD, PhD
Anna Marta Degener, PhD; Alessandra Pierangeli, PhD
Salvatore Martellucci, MD; Marco de Vincentiis, MD
Objective: A synergistic effect between smoking and alcohol intake is the major cause of
premalignant and malignant lesions of the larynx but the risk factors and pathogenesis of the
neoplastic transformation in nonsmokers remain poorly defined. The aim of this retrospective
study is to establish the relationship between smoking habits and HPV infection in laryngeal
dysplasia.
Methods: HPV DNA was amplified from 30 paraffin-embedded laryngeal dysplasia
tissue specimens by the polymerase chain reaction (PCR) using two groups of different consensus
primers. 15 samples were taken from smokers and 15 from nonsmokers.
Results: The present investigation failed to demonstrate HPV genome in all samples of
laryngeal precancerous lesions.
Conclusions: The absence of viral genomes in laryngeal dysplasia specimens of smokers
as well as nonsmokers suggests that other factors play a more important role than HPV infection
in the carcinogenesis of these lesions, being that laryngopharyngeal reflux is the most implicated
risk factor.
Extra-Esophageal Reflux & Surgical Fundoplication: What Parameters Predict
Symptomatic Improvement?
David O. Francis, MD; Marion Goutte, BS
James C. Slaughter, PhD; C. Gaelyn Garrett, MD
Michael Holzman, MD; Michael F. Vaezi, MD, PhD
Introduction: The role of surgical fundoplication in patients with refractory extraesophageal reflux (EER) symptoms is controversial. This study investigates the importance of
baseline patient demographic and physiologic parameters in response to surgery.
Methods: Of 350 patients with EER symptoms refractory to medical therapy who had
esophageal function testing, 27 patients with objective gastroesophageal reflux disease
underwent fundoplication surgery. Logistic regression determined which parameters predicted
improvement of presenting symptom.
Results: Symptomatic improvement occurred in 59% of patients’ 1-year postoperatively. Predictors of improvement were concomitant heartburn +/- regurgitation (OR 6.6,
95% CI 0.97 – 44.9, p=0.05) and pH<4 greater than 12% (OR 10.5, 95% CI 1.36 – 81.1,
p=0.02). Probability of improvement was 90.6% if both conditions were present. On PPI
therapy, impedance parameter did not predict response to therapy.
Conclusion: Baseline concomitant heartburn +/- regurgitation and esophageal pH<4
greater than 12% are predictors of post-operative improvement of presenting EER symptoms,
not impedance measures.
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Scientific Sessions
Efficacy of Large Diameter Dilatation in Cricopharyngeal Dysfunction
Matthew S. Clary, MD; Scott Keith, MD
Maurits Boon, MD; Joseph R. Spiegel, MD
A retrospective chart review was performed on 49 patients meeting the criteria for
cricopharyngeal dysphagia from 2004-2008 presenting in the outpatient setting. Patients were
treated with 60 French esophageal dilators. Outcomes were analyzed as a function of
symptomatology, manometry, duration of benefit, and safety. Over the period reviewed, 63
dilatations were performed on 49 patients. With cricopharyngeal dysfunction. 9 patients had more
than one dilation. The average starting Functional Outcome Swallowing Score (FOSS) was 1.86.
73.4% of patients experienced improvement in their FOSS with an average duration of 408.3
days. There were 5 minor complications and no major complications. In the largest series of
esophageal dilatation for cricopharyngeal dysfunction in the literature, we found large bore
bougienage to have significant utility due to its efficacy, ease of use, safety, and low cost when
compared to other modalities such as botulinum injection, balloon dilatation, and cricopharyngeal
myotomy.
A Histological Examination of the Quadrangular Membrane
Nwanmegha Young, MD; Clarence T. Sasaki, MD
Introduction: The banality of laryngeal cancer spread is due in part to connective tissue
membranes. These membranes function as barriers to cancer and divide the larynx into subunits.
The field of laryngeal conservation surgery is based on these concepts. The quadrangular
membrane plays an important role hindering the lateral spread of cancer in the larynx. The
composition of this membrane has not been well described in the literature. In this study we
examined basic characteristics of the quadrangular membrane using histological techniques.
Methods: Whole-organ sections of the larynx were used. These sections were examined
under the microscope with stains specific for collagen and elastin.
Results: Examination of the sections revealed the quadrangular membrane is made up of
closely woven undulating collagen and elastic fibers.
Conclusion: The quadrangular membrane is a fibroelastic structure providing a barrier to
cancer spread.
65
Scientific Sessions
A New Method for Assuming Vocal Fold Shear Property with Surface Wave
Analysis
Masaru Yamashita, MD, PhD; Hirohito Kobayashi, PhD
It is still difficult to analyze vocal fold mucosal property in vivo. A new non-invasive
way to estimate shear property of vocal fold is proposed. In this method, the color image sets of
vibrating vocal fold from high speed camera were enlarged with two dimensional mathematical
interpolation and RGB saturation (equivalent to negative of black-white image) and layer of the
color image was extracted from each image frame. In the extracted RGB saturation images, wave
front of mucosal surface wave that arises in vibrating vocal fold and propagates away from the
vocal fold free edge was observed, tracked, and traveling speed was assessed (mean value
=1.413m/s). With introduction of the assumption of tissue homogeneity of vocal fold, the shear
wave speed (1.342m/s) was estimated to be 95% of surface wave speed. From deduced shear
wave speed, the shear modulus of healthy vocal mucosal surface was evaluated to be around
1800Pa.
Atypical Laryngeal Manifestations in Oral-Facial-Digital Syndrome, Type I
Robert W. Kopp II, BS; Anthony J. Mortelliti, MD
Joel E. Portnoy, MD
Oral-facial-digital (OFD) syndrome is a disease spectrum encompassing abnormalities of
the oral cavity, face, digits and several other organ systems. Classically, OFD type I is not
associated with laryngeal abnormalities, however, a 4 year-old girl with that clinical diagnosis
presented with a history of recurrent aspiration pneumonias and abnormal laryngeal findings on
bronchoscopy. Physical examination findings and brain magnetic resonance imaging were
consistent with her diagnosis of OFD type I. A telescopic laryngoscopy and bronchoscopy were
performed to better assess her larynx. A trifurcate epiglottis, bilateral vallecular pits with splitting
of the pharyngoepiglottic folds and an absent left aryepiglottic fold were noted during that
procedure as was normal distal tracheobronchial architecture. Included in this report are
intraoperative pictures illustrating these anomalies as well as a discussion of the various types of
Oral-Facial-Digital syndrome.
66
Scientific Sessions
Awake Flexible Fiber CO2 Laser Ablation of Tracheal and Subglottic Stenosis
Michael A. Zozzaro, MD; Erik Cohen, MD
Sanaz Harirchian, MD; Kim Murray, MD
Acquired subglottic and tracheal stenosis is often secondary to endotracheal intubation,
tracheotomy, burns, or systemic inflammatory diseases. Treatment strategies include
tracheotomy, endoscopic dilation or laser ablation, and open reconstruction including tracheal
resection and primary anastamosis, tracheoplasty or laryngotracheal reconstruction. Traditionally,
laser therapy utilized a microscope-mounted CO2 laser in patients under general anesthesia via
tracheostomy or with jet ventilation. With the development of a flexible fiber CO2 laser delivery
system, treatment via flexible fiberoptic bronchoscopy has become feasible. We present a
retrospective case series of 2 patients with thin, grade II and III acquired subglottic and upper
tracheal stenosis who were successfully treated with transnasal, flexible bronchoscopy with the
Omniguide CO2 laser fiber using topical anesthesia and without tracheostomy. This technique
has not been previously described in the literature. This technique may be safe and effective
without the need for tracheostomy in appropriately selected patients with acquired subglottic and
tracheal stenosis.
Bilateral Vocal Cord Paresis related to Vagal Nerve Stimulation
Jonathan M Sherman, MD; Jacqueline P Corey, MD
Nadieska Caballero, MD; Daniel E Martin, PhD
Vagal nerve stimulators are increasingly used for the treatment of refractory major
depressive disorder and epilepsy. Temporary, minor laryngeal side effects are common, but well
tolerated and include voice alteration, coughing, pharyngitis, and dyspnea. Permanent unilateral
vocal cord paresis on the implanted side affects 1% of patients. We report a case of new stridor
from bilateral vocal cord paresis two years after VNS implantation related to the stimulation
levels of the device. Contralateral paresis was intermittent, worsening with increasing levels of
stimulation and resolving completely when the device was turned off, while ipsilateral paresis
only resolved after removal of the device. This is the first reported case of bilateral paresis related
to VNS, and it represents a rare but important possible complication which should be considered
in the setting of laryngeal dysfunction even years after VNS implantation.
67
Scientific Sessions
Complete Laryngeal and Tongue Dysfunction in an Acute LVAD Patient: An
Airway, Feeding, and Voice Dilemma
Yi-Hsuan Emmy Wu, MD; Thomas Carroll, MD
We present a challenging case of airway, feeding and voice management in a left
ventricular assist device (LVAD) patient. A 43 year old male demonstrated aphonia after LVAD
placement. Exam revealed motor tongue dysfunction and flexible laryngoscopy revealed an
insensate larynx and bilateral vocal fold immobility in the abducted position. An inability to
swallow and persistent aspiration obligated nasogastric tube (NGT) placement, and tracheostomy
was performed for pulmonary toilet. Aspiration persisted. It was felt the NGT acted as a conduit
around which laryngopharyngeal reflux was occurring. Resistance from the cardiothoracic
surgery team was met regarding replacement of the NGT with a Jejunosotmy (J) tube due to
concerns of potential LVAD infection and removal from the transplant list. Bilateral vocal fold
augmentation was subsequently performed for voice improvement. Recurrent aspiration
pneumonias became antibiotic resistant obligating NGT removal and J tube placement. The
patient’s tongue symptoms and aspiration subsequently improved dramatically.
Co-Prevalence of Tremor in Patients with Spasmodic Dysphonia:
A Case-Control Study
Laura White, BS; H.A. Jinnah, MD, PhD
John Hanfelt, PhD; Michael M. Johns II, MD
Although there is no cure for essential vocal and body tremor, pharmacologic therapy and
botulinum toxin injections yield significant improvement. The goal of this study is to define the
co-prevalence of essential tremor with spasmodic dysphonia (SD). A single institution casecontrol study was performed from May to July 2010. Consecutive patients with SD and benign
voice disorders were enrolled prospectively. Each participant underwent a brief neurological
exam. 146 benign voice disorder controls and 128 patients with SD were enrolled. Patients with
SD were 2.8 times more likely to have essential tremor than the control group (OR = 2.81; 95%
CI, 1.55 to 5.08) and only 35% of patients with SD had been seen by a neurologist for the
evaluation of SD. It is important for each patient diagnosed with SD to undergo a complete
neurological evaluation for body tremor, this is especially important in patients diagnosed with
vocal tremor.
68
Scientific Sessions
Diagnosis of Chronic Cough Due to Bordatella Pertussis in the Adult Population
Jonathan M. Bock, MD; Michael O. Frank, MD
Introduction: Incidence of Bordatella pertussis infection among adults has risen
significantly throughout the United States, but pertussis is not often considered in the differential
diagnosis of chronic cough in adults. IgG testing can establish diagnosis of a recent infection late
in presentation when cultures are no longer useful.
Methods: 8 adults with chronic cough with positive serology for B. pertussis over 15
months are presented, and institutional B. pertussis IgG tests were reviewed since 2006.
Results: 24 total patients were tested for B. pertussis IgG level since 2006, and 7 of 9
positive IgG tests occurred during the last 15 months. Many patients with positive serology had
post-tussive emesis and syncope.
Conclusions: B. pertussis IgG testing and patient history can help establish diagnosis of
pertussis in the adult patient with chronic cough late in presentation. This data also supports the
inclusion of pertussis in the differential diagnosis of adults with chronic cough.
Differential Expression of TGF-ß Isoforms 1 and 3 Following Vocal Fold Mucosal
Injury
Zhen Chang, PhD; Ayesha Hasan, BS
Yo Kishimoto, MD; Ayami Kishimoto, MD
Nathan V. Welham, PhD
Transforming growth factor beta (TGF-β) isoforms differ in abundance and regional
localization in various tissues and play crucial and distinct roles during wound healing.
Specifically, TGF- β1 has been associated with fibrotic healing whereas a high ratio of TGFβ3/β1 has been associated with regenerative healing. The mechanisms underlying these
differences are unknown. The purpose of this study was to characterize the expression and
localization of TGF-β1 and β3 in naïve and injured vocal fold mucosa, compared with oral
mucosa and skin. Immunohistochemistry revealed differential localization of TGF-β1 and β3 by
tissue type. Quantitative real time polymerase chain reaction (qRT-PCR) revealed a dramatic
increase in TGF-β1 transcription post-injury, compared with a moderate increase in TGF-β3. The
differential TGF-β isoform localization/expression patterns identified here may play a role in the
severity of scar formation; if so, manipulating the relative abundance of TGF-β3/ β1 during the
acute post-injury phase may improve injury outcomes.
69
Scientific Sessions
Efficacy of Laryngeal Botulinum Toxin Injection: Comparison of Two Techniques
Susan L. Fulmer, MD; Albert L. Merati, MD
Joel H. Blumin, MD
Objectives: It is hypothesized that there is no difference in the effectiveness of botulinum
toxin(BTX) injection between electromyography (EMG) guided and non-EMG guided ‘pointtouch’ techniques in treatment of adductor spasmodic dysphonia (AdSD). Study Design:
Retrospective chart review.
Methods: Patients selected for evaluation underwent sequential treatment by both of the
senior authors utilizing two different injection techniques with similar BTX dilution &
preparation. Data gathered included dose injected, injection effect, presence and duration of
breathiness and dysphagia after injection. Statistical analysis was performed used a generalized
estimating equations model.
Results: Four hundred seventeen injections in sixty-four patients were analyzed. There
was no difference in the rate of successful injections between the EMG guidance group and the
non-EMG guidance group (94.4% and 93.2%, respectively; p = 0.7).
Conclusions: This unique study demonstrates that efficacy of BTX does not depend on
the method of injection utilized. Excellent clinical results can be achieved with either EMG or
non-EMG guided injection techniques.
Endoscopic Lysis with Keel Placement for Anterior Glottic Webs
Randal C. Paniello, MD; Sid M. Khosla, MD
Purpose: to review and describe our clinical experience with this novel approach to a
difficult clinical problem.
Methods: retrospective case series (chart review)
Results: 14 patients were identified for inclusion, ranging in age from 24 to 62. The
surgical procedure involves laryngoscopy with complete lysis of the anterior glottic web by laser
or sharp technique, followed by placement of a square of silastic that is sutured in place using the
Lichtenberger needle holder, and left in place for 4-6 weeks. The procedure was well tolerated,
and successfully corrected the web in all but one case. The procedure does not require a
tracheotomy, and the patients can swallow a normal diet and have a surprisingly good voice while
the keel is in place.
Conclusion: This approach to treating anterior glottic webs offers several advantages over
traditional open thyrotomy with keel placement, and should be considered in patients with
symptomatic anterior glottic webs.
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Scientific Sessions
Evaluation of Dysphonic Patients by General Otolaryngologists
Seth M. Cohen, MD, MPH; Michael Pitman, MD
J. Pieter Noordzij, MD; Mark S. Courey, MD
Objective: To investigate instruments used by general otolaryngologists to visualize the
larynx, assess their perception of the instruments’ capabilities, and understand their comfort
diagnosing specific etiologies of dysphonia.
Methods: 1000 randomly chosen AAOHNS general otolaryngologists were mailed a
survey.
Results: The response rate was 27.8%. Mean years in practice were 19.5. Mirror and
fiberoptic laryngoscopy were most commonly used. 84.1% obtained stroboscopy. 33.7% reported
laryngoscopy could assess vibration. 82.4% believed laryngoscopy could assess mucosal detail
while 68.1% thought stroboscopy could. Respondents were more comfortable diagnosing
conditions with obvious laryngeal anatomic abnormalities compared to those without, such as
central neurologic disorders (p ≤ 0.001). 46.5% were concerned about over-diagnosing
laryngopharyngeal reflux.
Conclusions: Though 84.1% of general otolaryngologists use stroboscopy, one third may
not appreciate differences between stroboscopy and laryngoscopy. General otolaryngologists are
less comfortable diagnosing voice disorders without obvious laryngeal anatomic abnormalities,
and nearly 50% are concerned they over-diagnose reflux.
Explant Culture of Fibroblasts Obtained from Chronically Scarred Rat Vocal Folds
Yo Kishimoto, MD; Ayami Kishimoto, MD
Diane M. Bless, PhD; Nathan V. Welham, PhD
Vocal fold fibroblasts are widely used in vocal fold biology research and are considered a
therapeutic target in vocal fold scarring; however, the majority of published vocal fold fibroblast
work has involved cells harvested from normal tissues. Scar fibroblasts may exhibit a different
phenotype than their normal counterparts, and if so represent an important area of investigation.
The purpose of this study, therefore, was to characterize differences between scar and normal
vocal fold fibroblasts in culture. We performed explant culture using rat vocal fold tissue
harvested two months post-injury, and age/sex-matched non-injury controls. We examined cell
growth and proliferation rates, transcription and translation of major extracellular matrix
constituents, and gel contraction capacity. Scar fibroblasts appeared phenotypically different than
controls, but these differences became less apparent with subsequent culture passages. Ongoing
work with scarred vocal fold fibroblasts may be helpful in the advancement of new strategies for
treating vocal fold scar.
71
Scientific Sessions
Globus Sensation is Associated with Abnormal Esophageal Bolus Transit
Catherine J. Rees, MD; Kristin K. Marcum, MD
Nicholas Musisca, MS; Susan G. Butler, PhD
Introduction: Globus sensation is feeling of a lump or foreign body in the throat
sometimes associated with dysphagia. High resolution impedance manometry (HRIM) allows for
assessment of esophageal function and bolus transit and can be a useful tool in evaluating globus
sensation.
Methods: 180 esophageal HRIM studies were reviewed, excluding achalasia and
scleroderma. The Reflux Symptom Index items were correlated with the bolus transit findings,
including the item pertaining to globus (scored 0-5).
Results: Globus scores 2-5 were significantly associated with abnormal bolus transit for
liquids and viscous, compared to globus score 1 (p=0.019 and p=0.029, respectively). Throat
clearing and excessive throat mucus were not associated with abnormal bolus transit. The odds
ratio for abnormal liquid bolus transit with a globus score greater than 1 ranged from 3.5 to 8.
Conclusion: Globus sensation is strongly associated with abnormal bolus transit in the
esophagus in this tertiary care population.
Histopathologic Investigations of the Unphonated Human Vocal Fold Mucosa for a
Decade
Kiminori Sato, MD, PhD; Hirohito Umeno, MD
Takeharu Ono, MD; Tadashi Nakashima, MD
Vocal fold stellate cells (VFSCs) in the human maculae flavae (MFe) are inferred to be
involved in the metabolism of extracellular matrices (EMs) essential for the viscoelasticity of the
human vocal fold mucosa. We hypothesized that the tension caused by phonation (vocal fold
vibration) stimulates VFSCs to maintain the EMs. Vocal fold mucosa unphonated for 11 years
and 2 months of a 64-year-old male with cerebral hemorrhage was investigated by light and
electron microscopy. The vocal fold mucosae (including MFe) were atrophic. The vocal fold
mucosa did not have a vocal ligament, Reinke’s space or a layered structure. The lamina propria
appeared as a uniform structure. Morphologically, the VFSCs synthesized fewer EMs, such as
fibrous protein and glycosaminoglycan. And VFSCs appeared to decrease their level of activity.
Vocal fold vibration is an important factor in the maintenance of EMs of the human vocal fold
mucosa as a vibrating tissue.
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Scientific Sessions
Imaging Mass Spectrometry for the Analysis of Vocal Folds
Ichiro Tateya, MD, PhD; Yoshinori Takizawa, MD
Seiji Ishikawa, MD; Morimasa Kitamura, MD
Mitsutoshi Setou, MD, PhD; Juichi Ito, MD, PhD
Extracellular matrix components, such as hyaluronic acid, collagen, and elastin, are
known to be present in the vocal fold lamina propria and contribute to maintain the property of
the lamina propria. However, little is known about what other molecules are present in the lamina
propria. Imaging mass spectrometry (IMS) is the next generation tool for research in the postgenomics era which visualizes the distribution of thousands of known/unknown molecules, such
as phospholipids, proteins, and glycolipids, on a tissue section. This study is the first to analyze
the vocal fold by IMS. Canine vocal folds were crio-sectioned and the sections were used for the
analysis. In the preliminary study, IMS identified lysophosphatidylcholine molecules which are
specifically expressed in the lamina propria and phosphatidylcholine molecules which are
expressed in the macula flava. IMS is a powerful tool to perform in situ proteomics and will lead
to understand vocal fold structure and vibration.
Impact of Acute Oxidative Stress on Barrier Properties of Vocal Fold Epithelia
Rebecca Alper, MD; Elizabeth Erickson-Levendoski, MS
Sherleen Fu, BS; Wei Zheng, PhD
Mahalakshmi Sivasankar, MD
Vocal fold epithelium is exposed to oxidative stress via cigarette smoke, vehicle, and
industrial pollution. Oxidative agents are respiratory irritants, and may compromise barrier
properties of intestinal epithelia. The purpose of this study was to quantify the adverse effects of
acute oxidative stress on the barrier properties of vocal fold epithelia. This is an important area of
investigation as a compromised epithelial barrier may increase vulnerability of the underlying
vocal fold connective tissue to inflammation and injury. Electrophysiology, immunoblotting, and
light microscopy were used to investigate the structural and functional impact of oxidative stress
on vocal fold epithelial barrier. Freshly harvested porcine vocal fold epithelia were exposed to
hydrogen peroxide for two hours to model acute oxidative stress. Acute oxidative stress did not
reduce barrier protein concentration or epithelial resistance. These data provide the groundwork
for future investigations on the effects of various environmental pollutants on vocal fold
physiology.
73
Scientific Sessions
Incidence of Distinct Benign Mid-Membranous Vocal Fold Lesions as Classified
with a Novel Paradigm System
Clark A. Rosen, MD; Jackie Gartner-Schmidt, PhD
Robert T. Sataloff, MD, DMA; Greg Postma, MD
C. Blake Simpson, MD; Mark S. Courey, MD
Imprecision with nomenclature for benign vocal fold lesions (BVFL), results in miscommunication and impedes outcomes research. Our purpose was to develop and test the efficacy
of a BVFL nomenclature paradigm. Clinical consensus conferences were held to create a multidimensional BVFL nomenclature system based on still light morphology, stroboscopic findings,
response to voice therapy and intra-operative findings. Video analysis was performed to validate
the stroboscopy component of the schema. A retrospective review of 45 BVFL patients was
performed to assess the incidence of different types of BVFL. The nomenclature paradigm
resulted in nine distinct vocal fold lesions: nodules, polyp, pseudocyst, cyst
(subepithelial/ligament), fibrous mass (subepithelial/ligament), non-specific VF lesion and
reactive lesion. Video analysis demonstrated validity to the stroboscopy aspect of the paradigm.
The two most common lesions were vocal nodules and non-specific VF lesions. This novel
nomenclature paradigm permits consistent classification of BVFL and may facilitate outcomes
research for specific lesions and treatment modalities.
Intubation Granuloma of the Membranous Vocal Fold
Scott Rickert, MD; Vikash Modi, MD
Robert Ward, MD; Lucian Sulica, MD
Objectives: To describe the clinical features of granuloma of the membranous vocal fold
secondary to traumatic intubation, an uncommon entity.
Methods: Retrospective review of 5 cases from one tertiary institution.
Results: 5 patients were identified with post-intubation granuloma of the membranous
vocal fold. 3 patients were adults (age 49-80, mean 65) and 2 patients were children (age 9 days
and 14 days). None noted hoarseness prior to intubation and all noted significant hoarseness postoperatively. Intubation time ranged from 4 hours to 3 weeks. Conservative treatment of proton
pump inhibitors and voice rest was initially implemented with all adult patients. 2 of 3 (66.7%)
failed conservative treatment. All patients undergoing surgical intervention noted excellent postoperative results.
Conclusion: Intubation granuloma of the membranous vocal fold is an uncommon event
that presents early in the post-operative period. Surgical treatment should be advocated for those
failing initial conservative treatment.
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Scientific Sessions
Klebsiella Pneumoniae Descending Cervical Necrotizing Fasciitis Originating as a
Paraglottic Abscess
Justin S. Golub, MD; Sandy Mong, MD
Philip A. Weissbrod, MD; Thomas K. Varghese, MD
Tanya K. Meyer, MD
Introduction: Cervical necrotizing fasciitis (CNF) caused by monomicrobial Klebsiella
infection is a rare entity. We present the first known case report of Klebsiella CNF in the United
States and evaluate the literature for changing microbial patterns and sites of origin.
Methods: Case report and literature review
Results: A 30 year-old male presented with a paraglottic abscess and newly diagnosed
diabetes. Transoral drainage yielded pansensitive Klebsiella pneumoniae. The patient’s clinical
course deteriorated despite culture directed antibiotics. Repeat imaging showed inflammation of
cervical and mediastinal tissue planes. Wide cervical incision, sternotomy, and multiple
debridements were required. The patient was discharged on day 40. Literature documenting CNF
describes predominantly polymicrobial or gram positive organisms, most commonly with a dental
origin, and reports of monomicrobial Klebsiella necrotizing fasciitis are largely isolated to Asia.
Conclusions: The microbiology of CNF is varied and evolving. Clinicians must be aware
of changing patterns for early diagnosis and treatment.
Laryngeal Hematoma after Strangulation Injury
Jeffrey Cheng, MD; Benjamin D. Malkin, MD
Nancy Jiang, MD
Objective: To describe an unusual case of a progressive laryngeal hematoma after a
strangulation injury resulting in respiratory compromise.
Methods: Case review and review of the related English literature.
Results/case report: Our patient developed a supraglottic hematoma and cricoid fracture
after a strangulation injury. The patient required an emergent, awake tracheostomy several hours
after presentation for impending airway collapse and underwent delayed repair of the cricoid
cartilage fracture. The hematoma fully resolved on day 9. The patient was decannulated and
discharged home with normal vocal cord mobility and no postoperative complications.
Conclusion: Strangulation injuries necessitate careful and vigilant clinical evaluation and
may in rare cases progress to life threatening airway compromise or collapse. Clinical suspicion
should be raised in those patients who are symptomatic and have positive physical exam findings
and abnormal flexible fiberoptic laryngoscopic examinations. Establishment of a secure airway
should be of utmost importance, with tracheostomy being a life-saving measure in some cases.
75
Scientific Sessions
Lysis of Interarytenoid Synechia (Type I Posterior Glottic Stenosis): Vocal Fold
Mobility and Airway Results
Tanya K. Meyer, MD; Jeffrey Wolf, MD
Background: The Type I Posterior Glottic Stenosis (TI-PGS) is a well described entity
but there is little known about the outcome of surgical treatment.
Methods: Retrospective case series.
Results: Thirteen cases met inclusion criteria. All but one patient had a tracheotomy at
the time of initial evaluation. At the post-operative visit, seven patients (54%) had completely
normal vocal fold motion. Of the verbal patients, six (50%) had normal vocal function as reported
by both the patient/caregiver and the physician, and ten (83%) patients were successfully
decannulated.
Conclusions: Patients with an isolated interarytenoid synechiae have an excellent
prognosis with regard to decannulation. Although many patients regain normal vocal fold motion
and a return to their pre-intubation vocal function, a significant proportion can have persistent
deficits in vocal fold mobility and some level of dysphonia.
National Perspective on Tracheotomy Outcomes and Complications Presents
Opportunities for Targeted Improvements
Rahul K. Shah, MD; Brian Nussenbaum, MD
Lina Lander, ScD; Albert Merati, MD
David W. Roberson, MD
Introduction: To determine national rates of tracheotomy frequency, outcomes and
complications.
Methods: Analysis of public national database (NIS) from 2006.
Results: 117,998 tracheotomies were performed (58.1% male, average age 58.8); 12.2%
had complications and 7.8% died. Patients with complications were on average younger (52.3,
p<.0001) and those who died older (63.5, p<.0001). Tracheotomies were performed mostly in
urban settings (96.4%). Predictors of higher complication rates were rural setting (3.5%,
p<.0001), non-teaching hospital (32.3%, p<.0001), admission from long term care facility (2.7%,
p<.0001) and Medicaid insurance (15.9%, p<.0001). Predictors of higher mortality rates were the
same: rural setting (3.5%, p<.0001), non-teaching hospital (32.3%, p<.0001), admission from
long term care facility (2.7%, p<.0001) and Medicaid (15.9%,p<.0001).
Conclusions: Tracheotomy is a common operation with substantial public health impact.
Both complications and death are common after tracheotomy. Identification of risk factors for
increased complication and mortality rates may allow targeted improvement interventions.
76
Scientific Sessions
Neurofibroma of the Vocal Fold in a HIV Patient Not Associated with
Neurofibromatosis Type 1
Heather J. Gomes, MD, MPH; Thomas Carroll, MD
Neurofibroma of the larynx is rare. We present a case of a true vocal fold (TVF)
neurofibroma and review the pertinent literature regarding the presentation, diagnosis and
management of laryngeal neurofibroma. To the best of our knowledge, this is the first report in
the English literature of a neurofibroma isolated to the TVF.
A 39 year old HIV positive male with hoarseness, who does not carry a diagnosis of
neurofibromatosis type 1 (NF-1), was found to have a TVF neurofibroma. Most reported cases of
neurofibroma of the larynx are associated with NF-1. Diagnosis of laryngeal neurofibroma can
only be confirmed on histology. Complete surgical excision is the treatment of choice for
localized small lesions. Long term follow up is necessary secondary to the possibility of
malignant transformation and recurrence. Neurofibroma of the larynx is rare but should be
considered in the differential diagnosis of a subepithelial TVF lesion.
New Hoarseness in Patients with a History of Laryngeal Radiation
Scott Rickert, MD; Dan Novakovic, MD
Lucian Sulica, MD
Purpose: To examine causes, presentation and treatment of hoarseness in patients with a
history of laryngeal radiation
Methods: All adults presenting to university laryngology service between 2007 and 2010
with new complaint of dysphonia and history of radiation were identified. Patients presenting
within 5 years of radiation were excluded. Demographics, details of treatment, including
stroboscopy and outcome were reviewed.
Results: Seven patients (6M/1F, mean age 60.4) were identified. Patients presented a
mean of 18.4 years after radiotherapy. Hemorrhagic polyps (six unilateral, one bilateral) were
identified in every case, as well as aberrant neovascularisation and variable stroboscopic
abnormalities. Five patients underwent surgery, with confirmation of diagnosis. Although voice
improved in all cases, recovery was prolonged and stroboscopic abnormalities persisted.
Conclusion: Hemorrhagic polyps appear to be the predominant cause of dysphonia in
patients with a remote history of laryngeal radiation. We hypothesize that post-radiation
neovascularization predisposes to hemorrhagic phonotraumatic injury and impaired postsurgical
healing.
77
Scientific Sessions
Objective Measurement of the Vocal Effort during Medialisation Thyroplasty: A
Feasibility Study
Marc Remacle, MD, PhD; Vincent Bachy, MD
Georges Lawson, MD; Vinciane Lejoly-Devuyst, MSc SLP
Antoine Giovanni, MD, PhD; Thierry Legou, PhD
Nayla Matar, MD
Rationale: Objective measurement of the subglottic pressure could contribute to the
choice of the implant’s size (IS) in metallization thyroplasty (MT).
Material and Methods: Patients with glottal insufficiency were enrolled in this
prospective study. They had a MT using a Montgomery implant® (Boston medical, Boston,
USA). The direct subglottic pressure (DSGP) was measured intraoperatively using a catheter
inserted in the cricothyroid membrane. The implant’s choice was based on acoustic results,
patient’s perception, fiberoptic examination and results of DSGP measured prior and after
placement of the implant.
Results: 5 patients were included in the study. The DSGP could be measured in all the
patients without increasing the surgical time or patients’ discomfort. The mean DSGP before and
after the placement of the implant was 15.9 and 11.2 cm H2O, respectively.
Conclusion: Perioperative measurement of DSGP is easy, feasible and might allow a
more objective choice of the IS in MT.
Onset and Offset Phonation Threshold Pressure and Flow in Excised Human
Larynges
Ted Mau, MD, PhD; Joseph Muhlestein, BS
Sean Callahan, MD; Kent T. Weinheimer, BS
Roger W. Chan, PhD
Objectives: 1. To determine the minimum subglottal pressure and transglottal air flow
required to initiate or sustain phonation. 2. To determine the effect of posterior glottic gap size on
phonation threshold pressure (PTP) and flow (PTF).
Study Design: Induced phonation of excised human larynges.
Methods: Nine human larynges were harvested within 24 hours post-mortem. The
subglottal pressure and flow at phonation onset and offset were measured on a bench apparatus.
PTP and PTF were determined at graded separation distances between the vocal processes.
Results: Large inter-subject variation was observed in PTP and PTF values. One-way ANOVA
showed no significant dependence of PTP and PTF on posterior glottic gap size.
Conclusions: This is the first reported series of onset and offset PTP and PTF in fresh
excised human larynges. The insensitivity of PTP and PTF to posterior glottic gap size may be
partially attributed to the bowed contour of the vocal folds in excised human larynges.
78
Scientific Sessions
Optimal Concentration of Hepatocyte Growth Factor for Treatment of the Aged
Rat Vocal Fold
Atsushi Suehiro, MD, PhD; Harry Wright, MD;
Laurence James, MD; Bernard Rousseau, PhD, CCC-SLP
Introduction: Hepatocyte Growth Factor (HGF) demonstrates beneficial properties in
restoring hyaluronan (HA) in the aged rat vocal fold. However, the optimal concentration of HGF
remains unknown. The purpose of the present study was to investigate the optimal concentration
of HGF for restoring HA in the aged rat vocal fold.
Description: Seventy-five 18 month old rats received serial injections of HGF in 10µl of
phosphate-buffered saline (PBS) at the following concentrations: 10ng/10µl, 50ng/10µl,
100ng/10µl, 200ng/10µl, or control (PBS only). Larynges were subsequently harvested for
histology and quantitative PCR.
Results: Alcian Blue staining revealed significantly increased HA deposition in the
100ng/10µl group, compared to control. These results were supported by qPCR, which revealed
upregulated HA synthase gene expression.
Conclusion: In the current study, increased HA gene transcript levels and deposition of
HA were found in the 100ng/10µl group.
Oropharyngeal Symptoms Following Suspension Microlaryngoscopy with a
Suspension Versus Fulcrum-Based Laryngoscope Holder
Taryn Davids, MD; Adam Klein, MD
Michael M. Johns II, MD
Introduction: Oropharyngeal symptoms post direct laryngoscopy have been well
described, we aim to compare symptoms following the use of two different laryngoscope
systems; The Universal Modular Glottiscope (UMG) with suspension gallows and the OssoffPilling laryngoscope with fulcrum-based Lewy arm stabilizer.
Methods: A prospective evaluation of symptoms was performed via survey study at
intervals pre- and post-operatively. Relevant peri-operative information was collected.
Results: Oropharyngeal symptoms following microlaryngoscopy include altered tongue
mobility, altered taste, tongue paresthesia, and dysphagia. While there was no statistically
significant difference in number of oropharyngeal complications between laryngoscope systems,
there was a strong trend towards greater number and duration of symptoms in the UMG group
versus the Ossoff-Pilling group.
Conclusion: We encourage the use of the system most comfortable to the operator that
maximizes field of view with minimal post-operative symptoms. In the case of the UMG
laryngoscope we encourage practitioners to counsel patients in the pre-operative setting with
regards to expected post-operative symptoms.
79
Scientific Sessions
Overcoming Nasal Discomfort - A Novel Method for Office Based Laser Surgery
Sunil P. Verma, MD; Seth H. Dailey, MD
Introduction: The passage of an esophagoscope or channeled laryngoscope for officebased laser laryngeal surgery can be limited by a patient’s nasal discomfort from septal deviation
or turbinate hypertrophy. We describe a novel method for delivering the laser fiber and
visualizing its effect in these situations.
Methods: A retrospective chart review was performed and procedural details were
recorded.
Results - Technical description: A patient was seated in the examination chair and
instructed to hold his/her own tongue. The surgeon held a rigid angled telescope for visualization
of the larynx in his nondominant hand and a laser fiber threaded through an Abraham cannula in
the opposite. Energy from the PDL, KTP and CO2 flexible laser fibers was delivered for
management of papilloma and leukoplakia.
Conclusion: For patients who cannot tolerate passage of a flexible transnasal
laryngoscope or esophagoscope during office-based laser laryngeal surgery, an attractive
alternative to surgery under general anesthesia is the transoral technique.
Patient Tolerance of Awake, In-Office Laryngeal Procedures (AIOLP): A MultiInstitutional Perspective
VyVy N. Young, MD; Libby J. Smith, DO
Lucian Sulica, MD; Priya Krishna, MD
Clark A. Rosen, MD
An increasing number of laryngeal procedures are performed in the office. However,
little is known about how well these procedures are tolerated and what factors determine
success/failure. Prospectively collected patient and physician surveys from 6 surgeons at 3
institutions describe patient tolerance of AIOLP. There were 105 AIOLP performed, including
vocal fold injection (68%), laser (18%), and TNE (7%). Average duration of procedures was
13+8 minutes. Procedure discomfort was “just as” or “better than” expected in 75%. Patients
reported an average of 37/100 on a discomfort scale. 92% of patients would agree to undergo
another AIOLP, and 95% would recommend AIOLP to other patients. Procedures were
completed successfully in 97%. Most common surgeon-reported difficulties included
uncontrolled gag reflex and copious secretions. This study encompasses multiple diagnoses,
procedures, and methods of anesthesia. Awake, in-office laryngeal procedures are exceptionally
well tolerated by patients, resulting in extremely high completion and satisfaction rates.
80
Scientific Sessions
Post-Operative Herpetic Laryngitis: A Rare Entity
VyVy N. Young, MD*; Priya Krishna, MD
Clark A. Rosen, MD
Infectious complications following phonomicrosurgery are rare. Reports of herpetic
laryngitis are in the literature, but none following microlaryngoscopy. We present a case of a 55year-old female who underwent microsurgical excision of a left VF lesion and KTP ablation of
bilateral vascular ectasias. Post-operative videolaryngostroboscopy demonstrated severe bilateral
laryngeal edema, erythema and ulcerations, encompassing an area greater than the original
surgical field. Initial management included voice rest, antibiotics, steroids, and aggressive reflux
treatment. The patient experienced prolonged vocal fold edema and poor voice outcome, which
ultimately resolved over 6 months. Clinical diagnosis of herpetic laryngitis was presumptively
made after the patient revealed a history of relapsing oral herpes incited by stress with a recent
episode prior to microlaryngoscopy. This case highlights the importance of thorough review of a
patient’s medical history. A protocol for pre-operative(prophylactic) antiviral therapy and
appropriate timing of surgery is presented for patients with history of herpes infection.
Preliminary, Prospective Investigation of the Utility of Nimodipine for Acute Vocal
Fold Paralysis
Clark A. Rosen, MD; Libby O. Smith, DO
Priya Krishna, MD; VyVy N. Young, MD
Jackie Gartner-Schmidt, PhD
Michael C. Munin, MD
Nimodipine has been shown to be beneficial for the recovery of acute vocal fold paralysis
(AVFP) in an animal model. A previous small clinical series using nimodipine showed promise.
A prospective, open-label trial of patients with AVFP (onset <4months) was performed using
nimodipine (4 mo). Early LEMG was performed to determine severity of neural injury. Fourteen
patients were treated with nimodipine. Two patients stopped treatment early, and 4 are too early
for analysis; thus 8 patients (11 paralyzed VF’s) were analyzed. Six patients experienced recovery
of purposeful motion (9/11 paralyzed VF’s). LEMG results showed good prognosis in 4 VF’s
(4/4 recovered) and poor/fair prognosis in 6 VF’s (4/6 recovered). Historical control LEMG
patients with poor/fair prognosis demonstrated 20% recovery, compared to 67% recovery in
nimodipine-treated patients with the same initial LEMG findings. This pilot study demonstrates
better than expected acute vocal fold paralysis recovery with the early administration of
Nimodipine.
81
Scientific Sessions
Proposed Classification System for Reporting KTP 532NM/PDL 585NM Laser
Treatment Effects of Vocal Fold Lesions
Pavan S. Mallur, MD; Michael M. Johns II, MD
Milan R. Amin, MD; Clark A. Rosen, MD
Currently no standard exists for reporting treatment results for the KTP/PDL lasers. The
goal of this study is to validate classification schema for reporting immediate tissue effects after
laser treatment. A five-point classification system was developed by clinical consensus. Video
recordings were made prospectively. Two for each effect were presented to 3 fellowship-trained
laryngologists, who were asked to classify each video based on the classification descriptions and
examples. The treatment effect classification includes non-contact angiolysis, epithelial
blanching, epithelial disruption, contact epithelial ablation, and contact epithelial ablation with
tissue removal. Intra-rater reliability, evaluated by repeating 2 of 10 clips, and inter-relater
agreement was good. This study reveals that standardized reporting of effects of KTP/PDL laser
is feasible. We believe that results of KTP/PDL treatment should be reported using this validated
classification system of immediate effect, along with laser settings and output. This will allow for
systematic evaluation of long-term treatment results.
Prospective Multi-Arm Evaluation of Surgical Treatments for Vocal Fold Scar and
Pathologic Sulcus Vocalis
Nathan V. Welham, PhD; Seong Hee Choi, PhD
Seth H. Dailey, MD; Charles N. Ford, MD
Jack J. Jiang, MD, PhD
Diane M. Bless, PhD
The purpose of this study was to compare the effectiveness of common surgical
treatments for vocal fold scar and pathologic sulcus vocalis. Patients with newly diagnosed vocal
fold scar/sulcus were assigned to one of three treatment modalities: Type I thyroplasty (n = 9),
injection laryngoplasty (n = 9) and graft implantation (n = 10); and followed for 18 months posttreatment. Thyroplasty and graft implantation led to reduced voice handicap with no
improvement in auditory-perceptual, acoustic, aerodynamic or vocal fold physiologic
performance. Injection laryngoplasty resulted in no improvement on any vocal function index.
Patients who underwent graft implantation exhibited the slowest improvement trajectory. Overall,
it appears that no single treatment modality is successful for the majority of patients, and there is
no evidence-based decision algorithm for matching a given treatment to a given patient. Progress
therefore requires the identification of predictive clinical features that can drive evidence-based
treatment assignment.
82
Scientific Sessions
Recurrent Non-Granulomatous Supraglottitis: Managing a Difficult and Rare
Disease
Levi Ledgerwood, MD; Peter Belafsky, MD, PhD
Objectives: 1) Discuss a case of non-granulomatous supraglottitis. 2) Discuss the
diagnosis and management of this rare disease entity.
Methods: Single case report for non-granulomatous supraglottitis.
Results: The patient is a 40 year old woman with an unremarkable medical history who
15 years ago developed the sudden onset of supraglottic edema and difficulty breathing following
a throat infection. She was intubated for five days, and subsequently extubated with good
recovery until five years later when the episode recurred. She has since developed supraglottic
edema without antecedent infection 6-7 times. An extensive work-up has yet to reveal a cause of
these episodes and recent biopsies to rule out granulomatous disease were also negative.
Conclusions: Non-granulomatous supraglottitis is a rare entity and remains a diagnosis of
exclusion. We discuss a potential algorithm for work-up of these patients and discuss
management strategies for their recurrent episodes of supraglottic edema.
Reducing Injury During Video-assisted Endotracheal Intubation: The "Smart
Stylet" Concept
Philip Weissbrod, MD; Albert L. Merati, MD
Introduction: The GlideScope™ and related products have gained wide use in
anesthesiology when difficult intubation is anticipated. Even when excellent visualization of the
larynx is achieved, successful intubation can be difficult and/or traumatic due to awkward angles
and rigid stylets.
Methods: Technical description of procedure and outcomes from intubation in a series of
laryngeal surgical patients.
Results: For difficult intubations, a GlideScope™ is used in combination with a flexible
bronchoscope acting as a manipulable “smart” stylet. The bronchoscope is not used for its light or
fiberoptic capacity, but only as a manipulable guide while using the Glidescope™ as a videoassisted laryngoscope. Our experience with a large series of patients is presented in this technical
paper along with illustrative videos.
Conclusion: The “smart stylet” concept allows for successful and safe endotracheal
intubation when used with the Glidescope™.
83
Scientific Sessions
Spasmodic Dysphonia Triggers: A Combined Clinical Experience of Over 300
Patients
Lesley Childs, MD; Scott Rickert, MD
Thomas Murry, PhD; Andrew Blitzer, MD, DDS
Lucian Sulica, MD
Purpose: Spasmodic dysphonia (SD) is a rare voice disorder that is generally considered
idiopathic. Nevertheless, many patients associate onset with specific events or factors. This study
intends to examine these patient perceptions, typically dismissed as irrelevant given our current
medical understanding.
Procedures: Retrospective chart review.
Results: A total of 350 patients with SD were identified. Of these, 169 had specific
memories of the onset of their disorder and 45% were described as “sudden”. Triggers in the
sudden onset group were identified 79% of the time and only 1% of the time in those who
reported gradual onset. Of the triggers identified, stress (42%), upper respiratory infection (33%)
and postpartum (10%) were most common.
Conclusions: The large proportion of patients who perceive SD to be sudden in onset puts
current understanding in question. Further study on associated triggers will help us to better
understand the etiology and eventually lead to a hopeful cure.
The Effect of Intraoperative Injection Laryngoplasty with Radiesse vs.
Medialization Thyroplasty with Silastic in Patients with Unilateral Vocal Fold
Immobility
James Ruda, MD; Michael S. Benninger, MD
Tom Abelson, MD; Douglas Hicks, MD; Claudio Milstein, PhD
Objective: Unilateral vocal fold immobility (UVFI) is a condition typically treated with
vocal fold injection vs. laryngeal framework surgery. This study sought to review the
effectiveness of intraoperatively performed injection laryngoplasty (IL) vs. medialization
thyroplasty (MT) in patients with UVFI.
Methods: From 2007-2010, UVFI pts were prospectively treated at our institution with
MT utilizing silastic implantation or IL with Radiesse Voice (ILRV) or Voice Gel (ILRVG).
Maximum phonation times, voice handicap index scores, were recorded for all pts, both pre/postoperatively.
Results: 52/96 pts were treated with IL vs. 46/98 patients treated with MT. Average VHI
scores in ILRV vs. ML pts decreased 49% vs. 55.6% at 4-6 weeks postoperatively and 73.8% vs.
81.9% at 24 weeks postoperatively, respectively. Average 4 week MPTs increased from 8 to 24.3,
20.5, 20.2 seconds among pts treated with MT, ILRV, ILRVG, respectively. Average MPTs of
MT pts did not decline after 9 months.
Conclusions: Intraoperative IL or MT provided improved pt phonation and subjective
vocal impairment. Use of MT provided the greatest prolonged phonatory benefit to our patients.
84
Scientific Sessions
The Incidence of Dysphagia in the Elderly with Unilateral Vocal Fold Paralysis
(UVFP)
Angela Cogburn Paddack, MD; Alissa Collins, BS
Ozlem E. Tulunay-Ugur, MD
Although the impact of UVFP on voice has been studied extensively, its effects on
swallowing have received less attention, especially in the elderly. Aim: We hypothesized that
elder patients with UVFP experience increased dysphagia and related complications. Methods: A
retrospective review of patients younger and older than 65 years old with UVFP was performed,
comparing symptoms, complications and treatment outcomes. Results: 8 of the 20 patients older
than 65 years old were PEG dependent, and 5 had a history of aspiration pneumonia. Fourteen
patients showed penetration and 12 aspirations, mostly with liquids. In the younger group, 6 of
the 22 were PEG dependent and 3 had pneumonia. All PEG dependent patients in this group had
other cranial nerve involvement or high vagal resections. Conclusions: Elder patients had more
severe dysphagia requiring a PEG tube, and were less likely to resume oral intake after surgical
intervention than the younger population.
The Role of NIM Nerve Monitoring System in Thyroidectomy
Sharon Hughes, BS; Naren Venkatesan, MD
Michael P. Underbrink, MD, MBA
Thyroidectomies are a standard procedure in Otolaryngology and are increasing in
frequency. The crucial step in thyroidectomies is identification of the Recurrent Laryngeal Nerve.
Damage to this nerve is the most significant complication of the procedure, resulting in
hoarseness and difficulty breathing. While anatomical knowledge is the main stay of preventing
an injury to the nerve, the NIM nerve monitoring system helps provide confirmation. Therefore, it
has become an integral and often standard part of thyroidectomies. However, it also begs the
question if the NIM system is worthwhile as it increases cost and may only add minimal
information after a surgeon has already anatomically identified the nerve. To evaluate the NIM
system, a retrospective study of all patients undergoing a thyroidectomy at UTMB-Galveston
from 1990-2010 was performed. The results of the study show that the difference between cases
with and without the NIM system is minimal.
85
Scientific Sessions
The Utility of Trial Vocal Fold Augmentation Using Saline
Lesley Childs, MD; Scott Rickert, MD
Daniel Novakovic, MPH, MBBS, BSc; Andrew Blitzer, MD, DDS
Purpose: To describe certain clinical settings in which trial vocal fold augmentation using
saline has proven useful, serving as a guide for further intervention.
Procedures: Retrospective chart review.
Results: Five patients have undergone trial vocal fold augmentation using saline. Two
patients with presbyphonia and tremor reported an increase in volume and were notably less
hyperfunctional. A third patient with unilateral vocal fold immobility and decreased sensation
from a CVA experienced improved swallowing capability. The fourth patient, an athlete, did not
complain of any difficulty breathing upon exertion. Each of these four patients ultimately
underwent successful formal injection laryngoplasty. The fifth patient with immobility and vocal
fold scar had separation of the non-scarred tissues prior to treatment of the scar using a 532-nm
laser, with plans for formal injection laryngoplasty in the future.
Conclusions: In certain individuals, trial vocal fold augmentation using saline represents
an effective means of guiding future therapy for glottic insufficiency.
Toward Improved Understanding of Common Causes and Consequences of
Dysphonia in the General Population
Seth M. Cohen, MD, MPH
Jaewhan Kim, PhD; Nelson Roy, PhD, CCC-SLP, ASHA-F
Carl Asche, PhD, MBA; Mark S. Courey, MD
Objective: To establish the etiologies of dysphonia diagnosed by primary care physicians
(PCPs) and otolaryngologists and to determine differences in cited etiologies by these groups.
Methods: The Thomson Reuters MarketScan database contains commercial claims data
from 100 employers, 12 health plans, and Medicare. Dysphonia-related ICD-9 codes were tallied
by frequency and provider specialty from July 1, 2004 to June 30, 2008.
Results: Approximately 30 million individuals were in the database. Roughly 500,000
patients, ages 0 to > 65 years, sought medical care for dysphonia. Half saw a PCP and half an
otolaryngologist. The three most prevalent ICD-9 codes overall were 464.00, 784.49, and 476.0;
464.00, 784.49, and 464.2 by PCPs; 784.49, 476.0, and 464.00 by otolaryngologists.
Conclusion: This study allows comparison of ICD-9 codes and associated costs between
PCPs and otolaryngologists and provides an initial understanding of the practice patterns
associated with the symptom of dysphonia in the general population.
86
Scientific Sessions
Ultrasound Assessment of Vocal Folds: A Correlation Study with Flexible
Fiberoptic Laryngoscopy
Jayme R. Dowdall, MD; Deepak Gupta, MD
Arvind Srirajaklidindi, MD; Randall Amis, MD
Adam Folbe, MD
Background: Perioperative examination of the vocal folds with flexible fiberoptic
laryngoscopy is not always feasible. Prior studies suggest vocal fold ultrasound may a useful
screening tool, however, correlation to laryngoscopy findings necessary. The purpose of the study
is to validate vocal fold ultrasound in the adult population and to correlate the ultrasound findings
to the assessment provided by flexible fiberoptic laryngoscopy.
Materials and Methods: This IRB approved study has initially enrolled seventeen adult
patients. Vocal fold ultrasound performed by the anesthesiologist is correlated with laryngoscopy
performed by the otolaryngologist.
Results: Assessment of vocal fold motion was congruent in fourteen patients with normal
vocal fold mobility; however, three patients undergoing vocal fold injections showed discordance
between the findings.
Conclusion: Vocal fold ultrasound may be useful to rule out vocal fold motion
abnormalities in the adult population. Abnormal findings on vocal fold ultrasound should be
correlated with subsequent laryngoscopy.
Use of a Novel Instrument to Determine Oxygen Consumption and Hemoglobin
Levels in Human Thyroarytenoid Muscle Pre and Post Exercise
Cari M. Tellis, PhD, CCC-SLP; Thomas L. Carroll, MD;
Michael Fierro; James J. Sciote, DDS, PhD; Clark A. Rosen, MD
Visible light spectroscopy (VLS) is the concept behind the FDA approved TSTAT®
device which monitors tissue oxygen and hemoglobin levels in many parts of the body. This
instrument has never been used in the larynx. VLS may be an answer to non-invasively assess
muscle function in individuals with movement-type voice disorders. Purpose: The purpose of this
novel, pilot study was to determine if VLS, using the TSTAT® device, is a reliable and valid
method of measuring oxygen and hemoglobin levels in the thyroarytenoid muscle of individuals
without voice disorders to provide information about typical muscle function. Procedures:
Measurements were taken in the thyroarytenoid muscle at baseline, after exercise, and after
recovery using VLS through channel-port flexible laryngoscopy and hollow laryngeal
electromyography needle. Results: Data were collected and analyzed. Conclusion: VLS can be
used to measure changes in oxygen saturation and hemoglobin levels pre and post exercise in
human thyroarytenoid muscle.
87
Scientific Sessions
Ventilatory Technique for Central Airway Obstruction
Michele P. Morrison, MD; Gregory N. Postma, MD
Objectives: To demonstrate various ventilatory techniques used in patients with CAO.
Study Design: Retrospective review of illustrative operating room cases and review of the
literature. Methods: A number of methods are available to ventilate individuals with CAO. These
include the traditional ventilating bronchoscope, supraglottic/subglottic jet ventilation, high
frequency jet ventilation, specialized jet ventilation tubes, and even cardiac bypass. Operating
room cases involving patients with tracheal obstruction from tumors, airway stenosis, and various
other conditions were looked at. These cases presented unique ventilatory challenges and are
reviewed. Some of the ventilatory techniques employed include unilateral jet ventilation and
coronary artery bypass.
Results: All subjects were successfully ventilated and the cause of CAO safely addressed.
Conclusions: Patients with CAO pose a unique ventilation difficulty. Knowledge of a
variety of different airway techniques will aid in the management of these difficult patients.
Vocal Fold Granulomas: A Series of 114 Granulomas in a Tertiary Care Center
Nadine V. Yammine, MD, MSc; Karen M. Kost, MD
Francoise P. Chagnon, MD; Daniel Kost-Stevenson
Objectives: To evaluate demographics, risk factors and treatment of patients with vocal
process (VP) granulomas.
Methods: A chart review from 1997 to 2010 was completed. The following data were
collected and analyzed: patient demographics, clinical presentation, risk factors, compliance,
treatment and outcomes.
Results: 114 granulomas in 92 patients were identified. At least 2 risk factors were
identified in 43 (47%) patients. Treatment included lifestyle and dietary modifications, speech
therapy, proton pump inhibitors, H2 antagonists, corticosteroids, antibiotics, Botulinum Toxin A
injection, vocal fold augmentation and surgery. Sixty five (71%) patients achieved resolution
(Mean: 1.4 years). Five (5%) patients had a recurrence, 23 (25%) patients did not resolve and 9
(10%) were lost to follow-up. Fifty one patients (56%) were compliant with treatment.
Conclusion: Treatment of VP granulomas includes a combination of conservative,
medical and surgical approaches. Patients reporting compliance with treatment had a higher rate
of resolution.
88
Scientific Sessions
Vocal Fold Vibratory Behavior Changes Following Surgical Treatment of Polyps
Investigated with High-Speed Video Endoscopy and Phonovibrography
Melda Kunduk, MD; Michael Döllinger, PhD
Joerg Lohscheller; Andrew J. McWhorter, MD
Vocal fold pathology and healing post-operatively can affect vibratory behaviors of the
vocal folds and limit videsostroboscopic evaluation. High-Speed Videoendoscopy (HSV)
addresses this limitation while allowing the evaluation of periodic and aperiodic vocal fold
vibration in an actual glottic cycle along the entire vocal fold length. The goal of the study is to
objectively quantify the changes in vocal fold vibratory dynamics pre and post-surgery using
HSV and the image analysis tool Phonovibrography (PVG). HSV data was collected from ten
subjects diagnosed with unilateral vocal fold polyps, pre -operatively and post-operatively, at one
week and one month. The objective PVG measures and further vocal fold vibratory features
describing the vibratory behavior were collected and analyzed. Preliminary data revealed marked
changes pre and post-operatively but little change following one week. The findings and their
implication for clinical practice on voice rest following phonosurgery and the future research will
be discussed.
89
MEMORIALS
HASKINS K. KASHIMA, MD
Dr. Haskins Kazunori "Chuck"
Kashima, an Emeritus Fellow and a noted
Baltimore otolaryngologist and a world
leader in the treatment of laryngeal disease,
passed away on November 11, 2010 in
Lutherville, Maryland at the age of 78.
A memorial service was held on
November 14, 2010 at the George Peabody
Library, 17 E. Mount Vernon Place.
Dr. Kashima had an international
reputation in laryngeal matters and surgery.
He was also an expert on the human
papilloma virus and its effect on the larynx,"
said Dr. Charles W. Cummings, former
chairman of the Johns Hopkins University
School of Medicine's department of
otolaryngology — head and neck surgery.
Dr.
Cummings,
a
longtime
colleague, stated, "Chuck was much more
than a relater of facts and statistics. He was a
human being who developed relationships
with patients that set him apart from most
physicians. And he was always smiling and
always
downplayed
his
many
accomplishments while talking about those
of his colleagues."
He was a 1954 graduate of Stanford
University and earned his medical degree
from the Yale University School of
Medicine in 1958. After completing an
internship in surgery at Washington
University's Barnes Hospital in St. Louis
and a residency in otorhino-laryngology, he
joined the staff at . the National Institute of
Health for three years which was followed
by his joining the faculty at Georgetown
University Hospital in 1969. Dr. joined the
Department of Otolarygology faculty at
John Hopkins in 1969 where he remained
until his retirement in 2000.
He
inducted
into
the
American
Laryngological Association as an Active
Fellow where he would later received the
Tucker Award in 1996 and the Newcomb
Award in 1997 in recognition of his service
to Laryngology and the Association. In
2001, he achieved Emeritus status.
Dr. Kashima lectured throughout the
world, conducted significant research on
recurrent respiratory papillomatosis and was
instrumental in bringing the CO2 laser to
Hopkins Hospital for use in the treatment of
laryngeal disease.
Although he is known within academic
medicine as a pioneer of clinical trials, Dr
Kashima will be remembered most as a
consummate clinician-teacher who encouraged
his colleagues, residents and students with every
interaction," Dr. Niparko said. He added: "Our
department was blessed with his presence. His
spirit lives on in our clinics and lecture halls."
Dr. Michael M.E. Johns, a former dean
of the Hopkins medical school, commented that
Dr. Kashima “was always looked to as a mentor,
a strong shoulder, and for his good advice. He
was also a person of great calmness, and when
he walked into a room, you suddenly felt good.
He was all about serenity and calmness and the
wisdom that he carried with himself."
Dr. Kashima enjoyed traveling, playing
tennis and fishing.
Dr. Kashima leaves as survivors, his
wife of 49 years, the former Joyce Lynn French;
sons, Dr. Matthew and Mark Haskins Kashima;
a daughter, Lisa Poling; and eight grandchildren
90
MEMORIALS
FRANK N. RITTER, MD, MS
It is with a heavy heart that I inform you of
the passing of Frank Nicholas Ritter, B.S.,
M.D., M.S. on Tuesday, November 16,
2010, at age 82. He resided in Ann Arbor.
The Mass of the Resurrection was
said at St. Thomas the Apostle Church in
Ann Arbor on November 22, 2010.
Dr. Ritter’s decision to become a
physician came at the age of 5 while
observing the care his maternal grandfather
gave to patients. . Our resident teaching
award is named in his honor.
Dr. Ritter received his M.S. degree
from the University of Michigan in 1958.
After interning at Mercy Hospital in Toledo,
OH, he was accepted at the University of
Michigan's Ear, Nose and Throat Program
which he completed in 1960. After
completing his ENT residency in 1960, he
entered private practice at St. Joseph Mercy
Hospital in Ann Arbor an as Clinical
Professor at the University of Michigan
Medicla Center where he was a popular
teacher and received numerous awards.
Dr. Ritter was a veteran of the United States
Air Force where he taught Flight Medicine
at the School of Aviation Medicine and
researched the effects of Space Travel in the
ears of pilots and crew. After completing his
E.N.T. residency in 1960, he entered private
practice at St. Joseph Mercy Hospital, Ann
Arbor, MI and was a Clinical Professor at
the University of Michigan Medical Center.
Dr. Ritter was a fine popular teacher and
was given the"Shovel Award" and the
Senior Award by the Medical Students.
Academically, he was the author of
70 scientific papers; published in medical
literature, author of several books pertaining
to the anatomy of the paranasal sinuses; and
a collaborator of many chapters in E.N.T.
textbooks. Recognized as an excellent
speaker, both domestic and internationally,
Dr. Ritter received numerous awards with
the most notable one the title of “Knoght of
the Equestrian Order of the Holy Sepulchre”
presented by Pope John Paul II. ."
While medicine was his vocation,
his avocation was the telling of jokes. He
could tell stories on the spur of a moment
about almost any subject. Whenever friends
were going to give a presentation, they
would ask him for an appropriate joke to
tell.
In addition to being a fellow in the
American Laryngological Association, Dr.
Ritter was a member of numerous other
professional and community organizations
including the AAO-HNS, ABOto, ABEA,
and the American Board of Emergency
Medicine. He served as the chairman or
president of many other local and regional
associations.
He is survived by his wife of 53 years,
Gertrude (Trudy) Frances Erlacher and their
four daughters and four sons, their spouses,
grandchildren and family and friends
throughout the U.S. and abroad.
91
MEMORIALS
JOYCE A. SCHILD, M.D.
Dr. Joyce A. Schild, an Emeritus Fellow of
the ALA, and a noted otolaryngologist
whose career at the University of Illinois at
Chicago Medical Center spanned four
decades, died April 25, 2010 at her home in
Albuquerque, New Mexico. She was 78.
Among the first women in the
otolaryngology, she was a true pioneer both
as a researcher and clinician, said Dr. J.
Regan Thomas, professor and head of the
University of Illinois at Chicago’s
Otolaryngology department.
"Joyce Schild broke ground in so many
ways," said Thomas. "As a researcher and
clinician, she was rigorous in her detail and
passionate about her work, advancing the
field, caring for patients, and mentoring
generations of students. And she was a
tremendous role model – not just for
women, whom she clearly inspired, but for
all those with she worked and served."
Born in Chicago, Schild attended Chicago
Public Schools and was a 1954 graduate of
the old University of Illinois Navy Pier
campus. Earning her medical degree in 1956
from the UIC College of Medicine, Schild
joined the faculty of the department of
otolaryngology head and neck surgery in
1958, serving until her retirement in 1996.
In 1984, Dr. Schild was inducted into the
ALA as an Active Fellow.
She was
presented the Gabriel F. Tucker Jr. Award in
1994. In 2002, she was elevated to Emeritus
status. She was also active with the
Triological Society and the American
Broncho-Esophagological Association
where she served as President in 1979. As a
member of the Chicago Laryngological and
Otological Society, she was the president in
1984.
Dr. Schild was widely recognized for her
work in the field of otolaryngology,
publishing dozens of papers and articles.
Shortly after retirement, Schild and her
husband, John Hegber, moved to New
Mexico. Schild is survived by her husband.
Private funeral services were held in New
Mexico. A memorial service in Chicago will
held in Chicago.
92
OFFICERS 1879 - 2011
Presidents
1879
1880
1881
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
Louis Elsberg
J. Solis-Cohen
F. I. Knight
G. M. Lefferts
F. H. Bosworth
E. L. Shurly
Harrison Allen
E. Fletcher Ingals
R. P. Lincoln
E. C. Morgan
J. N. Mackenzie
W. C. Glasgow
S. W. Langmaid
M. J. Asch
D. Bryson Delavan
J. O. Roe
W. H. Daly
C. H. Knight
T. R. French
W. E. Casselberry
Samuel Johnston
H. L. Swain
J. W. Farlow
J. H. Bryan
J. H. Hartman
C. C. Rice
J. W. Gleitsmann
A. W. de Roaldes
H. S. Birkett
A. Coolidge, Jr
J. E. Logan
D. Braden Kyle
James E. Newcomb
George A. Leland
Thomas Hubbard
Alexander W. MacCoy
G. Hudson Makuen
Joseph L. Goodale
Thomas H. Halsted
Cornelius G. Coakley
Norval H. Pierce
Harris P. Mosher
Harmon Smith
Emil Mayer
1923
1924
1925
1226
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942-43
1944-45
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
J. Payson Clark
Lee Wallace Dean
Greenfield Sluder
Chevalier Jackson
D. Bryson Delavan
Charles W. Richardson
Lewis A. Coffin
Francis R. Packard
George E. Shambaugh
George Fetterolf
George M. Coates
Dunbar Roy
Burt R. Shurly
William B. Chamberlain
John F. Barnhill
George B. Wood
James A. Babbitt
Gordon Berry
Thomas E. Carmody
Charles J. Imperatori
Harold I. Lillie
Frank R. Spencer
Arthur W. Proetz
Frederick T. Hill
Ralph A. Fenton
Gordon B. New
H. Marshall Taylor
Louis H. Clerf
Gordon F. Harkness
Henry B. Orton
Bernard J. McMahon
LeRoy A. Schall
Harry P. Schenck
Fred W. Dixon
William J. McNally
Edwin N. Broyles
Dean M. Lierle
Francis E. LeJeune
Anderson C. Hilding
Albert C. Furstenberg
Paul A. Holinger
Joel J. Pressman
Lawrence R. Boies
Francis W. Davison
1969
1970
1971
1972
1973
1974
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Alden H. Miller
DeGraaf Woodman
F. Johnson Putney
Frank D. Lathrop
G. Slaughter Fitz-Hugh
Daniel C. Baker, Jr
Joseph H. Ogura
Stanton A. Friedberg
Charles M. Norris
Charles F. Ferguson
John F. Daly
John A. Kirchner
Daniel Miller
Harold C. Tabb
M. Stuart Strong
John S. Lewis
Gabriel F. Tucker, Jr
Douglas P. Bryce
Loring W. Pratt
Blair Fearon
Seymour R. Cohen
Eugene N. Myers
James B. Snow, Jr
John M. Fredrickson
William R. Hudson
Byron J. Bailey
H. Bryan Neel III
Paul H. Ward
Robert W. Cantrell
John A. Tucker
Lauren D. Holinger
Gerald B. Healy
Harold C. Pillsbury III
Stanley M. Shapshay
Gerald S. Berke
W. Frederick McGuirt, Sr.
Robert H. Ossoff
Robert T. Sataloff
Gayle E. Woodson
Marshall Strome
Roger l. Crumley
Marvin P. Fried
Andrew Blitzer
93
Vice Presidents (First and Second)
1879
F.H. Davis
1929
William B. Chamberlin, Ralph A. Fenton
1880
W. C. Glasgow, J. O. Roe
1930
Harris P. Mosher, James A. Babbitt
1881
E. L. Shurly, W. Porter
1931
Joseph B. Greene, E. Ross Faulkner
1882
C. Seiler, E. F. Ingals
1932
Gordon Berry, Frank R. Spencer
1883
S. W. Langmaid, S. Johnston
1933
E. Ross Faulkner, Thomas S. Carmody
1884
J. H. Hartman, W. H. Daly
1934
Fordon B. New, Samuel McCullagh
1885
H.A. Johnson, G. W. Major
1935
Edward C. Sewall, H. Marshall Taylor
1886
E. C. Morgan, J. N. Mackenzie
1936
William P. Wherry, Harold I. Lillie
1887
J. N. Mackenzie, S. W. Langmaid
1937
Frank R. Spencer, Bernard J. McMahon
1888
W. C. Glasgow, C. E. DeM. Sajous
1938
Ralph A. Fenton, Frederick T. Hill
1889
F. Holden, C.E. Bean
1939
John H. Foster, Thomas R. Gittins
1890
J. O. Roe, J. H. Hartman
1940
Charles H. Porter, Gordon F. Harkness
1891
M. J. Asch, S. Johnston
1941
Arthur W. Proetz, Henry B. Orton
1892
S. Johnston, J. C. Mulhall
1942-3
Harold I. Lillie, Dean M. Lierle
1893
J. C. Mulhall, W. E. Casselberry
1944-5
John J. Shea, Thomas C. Galloway
1894
C.C.Rice, S. H. Chapman
1946
H. Marshall Taylor, C. Stewart Nash
1895
J. Wright, A. W. de Roaldes
1947
John J. Shea, Frederick A. Figi
1896
T. M. Murray, D. N. Rankin
1948
Henry B. Orton, Anderson C. Hilding
1897
A. W. MacCoy, H. S. Birkett
1949
LeRoy A. Schall, Fletcher D. Woodward
1898
J. W. Farlow, F.W. Hinkel
1950
W. Likely Simpson, Lyman, G. Richards
1899
T. A. DeBlois, M. R. Brown
1951
William J. McNally, Thomas C. Galloway
1900
H. L. Wahner, A. A. Bliss
1952
J. MacKenzie Brown, Edwin N. Broyles
1901
J. W. Gleitsmann, D. Braden Kyle
1953
Claude C. Cody, Daniel S. cunning
1902
G.A. Leland, T. Melville Hardie
1954
James H. Maxwell, Clyde A. Heatly
1903
J. H. Lowman, W. Peyre Porcher
1955
Robert L. Goodale, Paul H. Holinger
1904
Thomaso Hubbard, W. J. Freeman
1956
Henry M. Goodyear, Robert E. Priest
1905
J. L. Goodale, C. W. Richardson
1957
Frances H. LeJeune, Pierre P. Viole
1906
G. H. Makuen, A. R. Thrasher
1958
Charles Blassingame, Chevalier L. Jackson
1907
J. P. Clark, J. E. Rhodes
1959
James H. Maxwell, Oliver Van Alyea
1908
E. Mayer, F. R. Packard
1960
Walter Theobald, Anderson C. Hilding
1909
C. G. Coakley, H. O. Moser
1961
Julius W. McCall, P. E. Irlend
1910
Robert C. Myles, J. M. Ingersoll
1962
Paul M. Moore, Jerome A. Hilger
1911
F. C. Cobb, B. R. Shuly
1963
Paul M. Holinger, Lester A. Brown
1912
A. W. Watson, W. Scott Renner
1964
B. Slaughter Fitz-Hugh, Daniel C. Baker
1913
F. E. Hopkins, George E. Shambaugh
1965
C. E. Munoz-McCormick, Arthur J. Crasovaner
1914
Clement T. Theien, Lewis A. Coffin
1966
Lawrence R. Boies, G. Edward Tremble
1915
J. Gordon Wilson, Christian R. Holmes
1967
John F. Daly, Stanton A. Friedberg
1916
Thomas H. Halsted, Greenfield Sluder
1968
DeGraaf Woodman, John Murtagh
94
Vice Presidents (First and Second)
1917
John Edwin Rhodes, D. Crosby Greene
1969
Joseph P. Atkins, Stanton A. Friedberg
1918
George E. Shambaugh, John R. Winslow
1970
Robert B. Lewy, Oliver W. Suehs
1919
Francis R. Packard, Harmon Smith
1970
James A. Harrill, James D. Baxter
1920
Harmon Smith, W. B. Chamberlin
1972
Francis L. Weille, Sam H. Sanders
1921
Dunbar Roy,m Robert C. Lynch
1973
William H. Saunders, Blair Fearon
1922
George Fetterolf, Lorenzo B. Lockard
1974
Joseph H. Ogura, Douglas P. Bryce, John A. Kirchner
1923
Hubert Arrowsmith, Joseph B. Greene
1975
S. Lewis, Edwin W. Cocke, Jr.
1924
Ross H. Skillern, Gordon Berry
1976
Emanuel M. Skolnik, John T. Dickinson
1925
John E. Mackenty, Robert Levy
1977
J. Ryan Chandler, Herbert H. Dedo
1926
Lewis A. Coffin, William V. Mullin
1978
John E. Bordley, Lester A. Brown
1927
Charles W. Richardon, Hill Hastings
1979
Albert H.Andrews, Seymour R. Cohen
1928
Robert Cole Lynch, Francis P. Emerson
1980
John Frazer, George A. Sisson
Vice-Presidents (Presidents-Elect)
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
M. Stuart Strong
19 1992
John S. Lewis
1993
Gabriel F. Tucker, Jr
1994
Douglas P. Bryce
1995
Loring W. Pratt
1996
Blair Fearon
1997
Seymour R. Cohen
19 1998
Eugene N. Myers
1999
John B. Snow, Jr.
2000
John M. Frederickson
2001
William R. Hudson
2002
Byron J. Bailey
H. Bryan Neel, III
Paul H. Ward
Robert W. Cantrell
John A. Tucker
Lauren D. Holinger
Gerald B. Healy
Harold C. Pillsbury, III
Stanley M. Shapshay
Gerald S. Berke
W. Frederick McGuirt, Sr.
2003
2004
2005
2006
2007
2008
2009
2010
2011
Robert H. Ossoff
Robert T. Sataloff
Gayle E. Woodson
Marshall Strome
Roger L. Crumley
Marvin Fried
Andrew Blitzer
Clarence Sasaki
Clarence Sasaki
1900
1911
P. E. Newcomb
Harmon Smith
1977
1982
1988
1993
1998
2003
2008
William M. Trible
Eugene N. Myers
H. Bryan Neel III
Gerald B. Healy
Robert H. Ossoff
Marvin P. Fried
C. Gaelyn Garrett
Secretaries and Treasurers
1879
1882
G. M. Lefferts
D. Bryson Delavan
1889
1895
C. H. Knight
H. L. Swain
Secretaries
1911
1918
1919
1920
1933
1935
1939
Harmon Smith
D. Bryson Delavan
J. M. Ingersoll
George M. Coates
William V. Mullin
James A. Babbitt
Charles J. Imperatori
1942
1947
1952
1957
1959
1968
1972
Arthur W. Proetz
Louis H. Clerf
Harry P. Schenck
James H. Maxwell
Lyman G. Richards
Frank D. Lathrop
John F. Daly
95
Treasurers
1912
1912
1932
1933
1935
1939
1948
J. Payson Clark
George Fetterolf
William V. Mullin
James A. Babbitt
Charles J. Imperatori
Frederick T. Hill
Gordon F. Harkness
1953
1958
1962
1969
1976
1981
1985
Fred W. Dixon
Francis E. LeJeune
Alden H. Miller
Charles M. Norris
Harold G. Tabb
Loring W. Pratt
John M. Fredrickson
1990
1995
1999
2005
2006
Robert W. Cantrell
Harold C. Pillsbury, III
Robert T. Sataloff
Allen D. Hillel
Michael S. Benninger
Librarians
1879
1883
F. H. Bosworth
T. R. French
1903
1930
J. H. Bryan
John F. Barnhill
1934
1935
Burt R. Shurly
George M. Coates
1997
2000
2005
2008
Stanley M. Shapshay
Gayle E. Woodson
C. Gaelyn Garrett
Mark S. Courey
Librarian and Historian
1936
George M. Coates
1944
LoLouis H. Clerf
Librarian, Historian and Editor
1947
1952
1955
1960
1964
Harry P. Schenck
Bernard J. McMahon
Edwin N. Broyles
Francis W. Davison
F. Johnson Putney
1971
1977
1983
1989
1994
Charles F. Ferguson
Gabriel F. Tucker, Jr
James B. Snow, Jr
Paul H. Ward
Ernest A. Weymuller, Jr
Historian
2010
Robert H. Ossoff
96
DECEASED FELLOWS
Dates indicate original election to the Association
Honorary Fellows
1946
1992
1908
1983
1878
1940
1917
1925
1957
1960
1818
1881
1891
1893
1923
1879
1936
1880
1986
1903
1971
1943
1928
1948
1957
1907
1878
1878
Alonso, Justo M., Montevideo, Uruguay
Aschan, Gunnar K., Linköping, Sweden
Barnhill, John F., Miami Beach, FL
Birkett, Herbert S., Montreal, CN
Bosworth, Francke H., New York, NY
Broyles, Edwin N., Baltimore, MD
Coates, George M., Philadelphia, PA
Clerf, Louis H., St Petersburg, FL
Conley, John J., New York, NY
Daly, John F., Fort Lee, NJ
Dean, Lee Wallace, St Louis, MO
Delavan, D. Bryson, New York, NY
De La Sota y Lastra, Ramon, Seville, Spain
de Roaldes, Arthur W., New Orleans, LA
Fenton, Ralph A., Portland, OR
French, Thomas R., Brooklyn, NY
Galloway, Thomas C., Evanston, IL
Garcia, Manuel, London, ENG
Gould, Wilbur J., New York, NY
Harris, Thomas J., New York, NY
Harrison, Sir Donald F. N., Surrey, England
Hilding, Anderson C., Duluth, MN
Hill, Frederick T., Waterville, ME
Holinger, Paul H., Chicago, IL
Huizinga, Eelco, Groningen, the Netherlands
Jackson, Chevalier, Schwenksville, PA
Johnston, Samuel, Baltimore, MD
Lefferts, George Morewood, Katonah, NY
1914
1918
1933
1883
1881
1910
1904
1910
1937
1930
1818
1957
1906
1937
1924
1957
1932
1909
1878
1973
1889
1914
1903
1914
1948
1951
1890
Levy, Robert, Denver, CO
Lewis, Fielding O., Media, PA
Lierle, Dean M., Iowa City, IA
Mackenzie, John N., Baltimore, MD
Mackenzie, Sir Morell, London, ENG
Masser, Ferdinand, Naples, Italy
Mosher, Harris P., Marblehead, MA
Moure, J. J. E., Bordeaux, France
Nager, F. R., Zurich, Switzerland
Negus, Sir Victor E., London, ENG
Oliver, H. K., Boston, MA
Ono, Jo, Tokyo, Japan
Pierce, Norval Harvey, San Diego, CA
Portmann, Georges, Bordeaux, France
Proetz, Arthur C., St Louis, MO
Ruedi, Luzius, Zurich, Switzerland
Schall, LeRoy A., Boston, MA
Semon, Sir Felix, Great Missenden, England
Solis-Cohen, J., Philadelphia, PA
Som, Max L., New York, NY
Swain, Henry L., New Haven, CT
Thomson, Sir St Clair, London, ENG
Tilley, Herbert, London, ENG
Wagner, Clinton, New York, NY
Williams, Henry L., Rochester, MN
Woodman, DeGraaf, New York, NY
Wright, Jonathan, Pleasantville, NY
Corresponding Fellows
1978
1972
1942
1938
1892
1968
1964
1940
1901
1893
1966
1943
1930
1961
1936
1887
1901
1984
1970
1985
1919
1978
1881
1950
1931
1926
1921
Arauz, Juan Carlos, Buenos Aires, Argentina
Arslan, Michele, Padua, Italy
Batson, Oscar V., Philadelphia, PA
Blair, Vilray P., St Louis, MO
Browne, Lennox, London, England
Cawthorne, Sir Terence, London, England
Cleves, Carlos, Bogota, Colombia
Colledge, Lionel, London, England
Collier, Mayo, Kearsney Abbey, Kent, England
Desvernine, Carlos M., Havana, Cuba
Dohlman, Gösta, East Bradenton, FL
Eggston, Andrew A., New York, NY
Emerson, Francis P., Franklin, MA
Faaborg-Anderson, Kund, Nykobing, Denmark
Fraser, John S., Edinburgh,UK
Gougenheim, A., Paris, France
Grant, Sir James Dundas, London, England
Holden, Edgar, Newark, NJ
Hutcheon, Jack R., Brisbane, Australia
Inouye, Tetsuzo, Saitama, Japan
Kelly, Adam Brown, Helensburgh, Scotland
Kleinsasser, Oskar, Marburg, Germany
Labus, Carlo, Milan, Italy
Larsell, Olof, Portland, OR
LaSagna, Francesco, Parma, Italy
Law, Frederick M., New York
LeMaitre, Ferdinand, Paris
1902
1897
1970
1896
1894
1903
1920
1919
1880
1896
1950
1919
1941
1971
1919
1894
1924
1896
1946
1940
1881
1913
1936
1880
1901
1894
Lermoyez, Marcel, Paris, France
Luc, H., Paris, France
Macbeth, Ronald G., Oxford, England
MacDonald, Greville, Haslemere, England
MacIntyre, John, Glasgow, Scotland
McBride, P., York, England
McKenzie, Dan, London, England
McKernon, James F., New Canaan, CT
Meyer, Wilhelm, Copenhagen, Denmark
Mygind, Holger, Copenhagen, Denmark
Neil, James Hardie, Auckland, New Zealand
Paterson, Donald Rose, Cardiff, Wales
Patterson, Norman, Herts, England
Rethi, Aurelius, Budapest, Hungary
Rogers, John, Jr, New York, NY
Sajous, C. E. DeM., Philadelphia, PA
Schaefer, J. Parson, Philadelphia, PA
Schmiegelow, Ernst, Copenhagen, Denmark
Segura, Eliseo, Buenos Aires, Argentina
Soto, E. Fernandez, Havana, Cuba
Thornton, Pugin, London, England
Turner, A. Logan, Edinburgh, UK
Vialle, Jacques, Nice, France
Whistler, W. McNeil, London, England
Wingrave, Wyatt, Lyme Regis, England
Wolfenden, R. Norric, Kent, England
97
Deceased Fellows
Emeritus Fellows
1962
1936
1923
1915
1944
1928
1921
1944
1955
1941
1901
1955
1891
1963
1913
1930
1945
1942
1959
1897
1968
1899
1939
1964
1905
1957
1893
1959
1937
1941
1913
1951
1882
1966
1968
1941
1947
1952
1892
1964
1963
1930
1955
1922
1933
2010
1905
1956
1932
1940
1928
1880
1959
1922
1898
1940
1965
1932
1906
1917
1950
1970
1905
1965
1940
1896
Arnold, Godfrey E., Clinton, MS
Ballenger, Howard C., Winnetka, IL
Barlow, Roy A., Nova Scotia, Canada
Barnes, Harry Aldrich, Kingston, MA
Beatty, Hugh G., Columbus, OH
Beck, Joseph C., Chicago, IL
Berry, Gordon, Worcester, MA
Boies, Lawrence R., Minneapolis, MN
Bordley, John E., Baltimore, MD
Bowers, Wesley C., New York, NY
Brown, J. Price, Toronto, Canada
Brown, Lester A., Atlanta. GA
Bryan, Joseph H., Washington, DC
Bryce, Douglas P, Toronto Canada
Butler, Ralph, Philadelphia, PA
Campbell, Edward H., Philadelphia, PA
Campbell, Paul A., San Antonio, TX
Canfield, Norton, Miami, FL
Cardwell, Edgar P., Newark, NJ
Clark, J. Payson, Boston, MA
Chandler, J. Ryan, Miami, FL
Cobb, Frederick C., Bradenton, FL
Cocke, Edwin W. Jr., Memphis, TN
Cody, Claude C., Jr, Houston, TX
Cody, Claude C. III, Houston, TX
Coffin, Lewis A., New York, NY
Converse, John Marquis, New York, NY
Coolidge, Algernon, Boston, MA
Cracovaner, Arthur J., New York, NY
Crowe, Samuel H., Baltimore, MD
Cunning, Daniel S., New York, NY
Dabney, Virginia, Washington, DC
Davison, Francis W., Danville, PA
De Blois, Thomas Amory, Boston, MA
Devine, Kenneth, Rochester, MN
DeWeese, David D., Portland, OR
Dixon, Fred W., Shaker Heights, OH
Eagle, Watt W., New Bern, NC
Erich, John B., Rochester, MN
Farlow, John W., Boston, MA
Fearon, Blair W., Don Mills, Canada
Ferguson, Charles F., Sarasota, FL
Figi, Frederick A., Rochester, MN
Fitz-Hugh, G. Slaughter, Charlottesville, VA
Forbes, Henry H., New York, NY
Foster, John H., Houston, TX
Frazer, John, Rochester, NY
Freer, Otto T., Chicago, IL
Friedberg, Stanton A., Chicago, IL
Furstenberg, Albert C., Ann Arbor, MI
Gatewood, E. Trible, Richmond, VA
Gittins, Thomas R., Sioux City, IA
Gleitsmann, Joseph W., New York, NY
Goldman, Joseph L., New York, NY
Goldsmith, Perry G., Toronto, Canada
Goodale, Joseph L., Ipswich, MA
Goodale, Robert L., Ipswich, MA
Goodyear, Henry M., Cincinnati, OH
Graham, Harrington B., San Francisco, CA
Greene, D. Crosby, Jr, Boston, MA
Greene, Joseph B., Asheville, NC
Hall, Colby, Encino, CA
Halliday, Sir George C., Sydney, Australia
Halsted, Thomas H., Los Angeles, CA
Hanckel, Richard W., Jr, Florence, SC
Hansel, French K., St Louis, MO
Hardie, Thomas Melville, Chicago, IL
1960
1959
1915
1944
1942
1959
1955
1888
1944
1895
1930
1927
1919
1920
1904
1952
1928
1939
2010
1942
1918
1921
1965
1929
1950
1885
1939
1963
1939
1894
1961
1922
1943
1949
1976
1973
1927
1928
1886
1928
1941
1896
1966
1952
1951
1939
1943
1963
1951
1923
1933
1931
1952
1965
1964
1954
1957
1953
1939
1927
1901
1937
1922
1923
1958
1903
Harris, Herbert H., Houston, TX
Hart, Verling K., Charlotte, NC
Hastings, Hill, Los Angeles, CA
Havens, Fred Z., Rochester, MN
Heatley, Clyde A., Rochester, NY
Henry, G. Arnold, Lagoon City, Canada
Jerome A. Hilger, St. Paul, MN
Hinkel, Frank Whitehill, Buffalo, NY
Hoople, Gordon D., Syracuse, NY
Hopkins, Frederick E., Springfield, MA
Houser, Karl M., Ardmore, PA
Hubbard, Thomas, Toledo, OH
Hurd, Lee Maidment, Rowayton, CT
Imperatori, Charles J., Essex, NY
Ingersoll, John Marvin, Miami, FL
Ireland, Percy E., Toronto, Canada
Jarvis, DeForest C., Barre, VT
Johnston, William H., Santa Barbara, CA
Kashima, Haskins, Lutherville, MD
Kelly, Joseph D., New York, NY
Kenyon, Elmer L., Chicago, IL
Kernan, John D., New York, NY
King, James T., Atlanta, GA
Kistner, Frank B., Portland, OR
Kline, Oram R., Woodbury Heights, NJ
Knight, Charles H., New York, NY
Large, Secord H., Cleveland, OH
Lathrop, Frank D., Pittsford, VT
LeJeune, Francis E., New Orleans, LA
Leland, George A., Boston, MA
Lewy, Robert B., Chicago, IL
Lillie, Harold I., Rochester, MN
Lincoln, William R., Cleveland, OH
Lindsay, John R., Evanston, IL
Lingeman, Raleigh E., Indianapolis, IN
Loré, John M., Buffalo, New York, NY
Lukens, Robert M., Wildwood Crest, NJ
Lyman, Harry Webster, St Louis, MO
MacCoy, Alexander W., Philadelphia, PA
MacPherson, Duncan, New York, NY
Martin, Robert C., San Francisco, CA
Mayer, Emil, New York, NY
McCabe, Brian F., Iowa City, IA
McCall, Julius W., Shaker Heights, OH
McCart, Howard W. D., Toronto, Canada
McCaskey, Carl H., Indianapolis, IN
McCullagh, Samuel, New York, NY
McGovern, Francis H., Danville, VA
McHenry, Lawrence C., Oklahoma City, OK
McKinney, Richmond, Memphis, TN
McMahon, Bernard J., St Louis, MO
McNally, William J., Montreal, Canada
Miller, Alden H., Glendale, CA
Miller, Daniel, Boston, MA
Montgomery, William W., Boston, MA
Moore, Paul McN., Delray Beach, FL
Munoz-MacCormick, Carlos E., Santurce, PR
Murtagh, John A., Hanover, NH
Myers, John L., Kansas City, MO
Myerson, Mervin C., New York, NY
Myles, Robert C., New York, NY
Nash, C. Stewart, Rochester, NY
New, Gordon B., Rochester, MN
Newhart, Horace, Minneapolis, MN
O’Keefe, John J., Philadelphia, PA
Packard, Francis R., Philadelphia, PA
98
1961
1961
1948
1878
1942
1951
2004
1951
1963
1903
1897
1884
1905
1956
2010
1878
1938
1959
1921
1934
2010
1923
1930
1907
1558
1937
Pang, Lup Q., Honolulu, HI
Pastore, Peter N., Richmond, VA
Phelps, Kenneth A., Burlington, NC
Porter, William, Ocean Springs, MA
Potts, John B., Omaha, NE
Priest, Robert E., Edina, MN
Putney, F. Johnson, Charleston, SC
Rawlins, Aubrey G., San Francisco, CA
Reed, George F., Syracuse, NY
Renner, W. Scott, Buffalo, NY
Rhodes, John Edwin, Chicago, IL
Rice, Clarence C., New York, NY
Richards, George L., South Yarmouth, MA
Richardson, John R., Searsport, ME
Ritter, Frank, Ann Arbor, MI
Robinson, Beverly, New York, NY
Salinger, Samuel, Palm Springs, CA
Sanders, Sam H., Memphis, TN
Sauer, William E., St Louis, MO
Schenck, Harry P., Philadelphia, PA
Schild, Joyce, Alburquerque, NM
Sewall, Edward C., Palo Alto, CA
Seydell, Ernest M., Wichita, KS
Shambaugh, George E., Chicago, IL
Simonton, Kinsey Macleod, Ponte Vedra Beach, FL
Simpson, W. Likely, Memphis,TN
2006
1987
1950
1908
2004
1954
1923
1963
1947
1954
1927
1963
1950
1925
1943
1941
1892
1892
1948
1922
1939
1905
1935
1953
Sisson, George, Chicago, IL
Skolnik, Emanuel M., Chicago, IL
Smith, Austin T., Philadelphia, PA
Smith, Harmon, New York, NY
Soboroff, Burton, Chicago, IL
Sooy, Francis A., San Francisco, CA
Spencer, Frank R., Boulder, CO
Tabb, Harold C., New Orleans, LA
Theobald, Walter H., Chicago, IL
Thornell, William C., Cincinnati, OH
Tobey, Harold G., Boston, MA
Tolan, John F., Seattle, WA
Tremble, G. Edward, Montreal, Canada
Tucker, Gabriel, Haverford, PA
Van Alyea, Oliver E., Chicago, IL
Violé, Pierre, Los Angeles, CA
Wagner, Henry L., San Francisco, CA
Watson, Arthur W., Philadelphia, PA
Whalen, Edward J., Hartford, CT
White, Francis W., New York, NY
Wilson, J. Gordon, Old Bennington, VT
Wood, George B. Wynnewood, PA
Woodward, Fletcher D., Charlottesville, VA
Work, Walter, Green Valley, AZ
Active Fellows
2006
1958
1880
1969
1917
1879
1942
1958
1923
1906
1880
1949
1904
1924
1938
1893
1951
1895
1932
1892
1933
1915
1934
1924
1889
1883
1917
1882
1896
1902
1913
1918
1880
1878
1880
1878
1941
1926
1901
1969
1878
Adams, George L., Excelsior, MN
Alfaro, Victor R., Washington, DC
Allen, Harrison, Philadelphia, PA
Andrews, Albert H., Jr, Chicago, IL
Arrowsmith, Hubert, Brooklyn, NY
Asch, Morris J., New York, NY
Ashley, Rae E., San Francisco, CA
Atkins, Joseph P., Philadelphia, PA
Babbitt, James A., Philadelphia, PA
Ballenger, William L., Chicago, IL
Bean, C. E., St Paul, MN
Beck, August L., New Rochelle, NY
Berens, T. Passmore, New York, NY
Bigelow, Nolton, Providence, RI
Blassingame, Charles D., Memphis, TN
Bliss, Arthur Ames, Philadelphia, PA
Boyden, Guy L., Portland, OR
Boylan, J. E., Cincinnati, OH
Brown, John Mackenzie, Los Angeles, CA
Brown, Moreau R., Chicago, IL
Buckley, Robert E., New York, NY
Canfield, R. Bishop, Ann Arbor, MI
Carmack, John Walter, Indianapolis, IN
Carmody, Thomas E., Denver, CO
Casselberry, William E., Chicago, IL
Chamberlain, C. W., Hartford, CT
Chamberlin, William B., Cleveland, OH
Chapman, S. Hartwell, New Haven, CT
Chappell, W. F., New York, NY
Coakley, Cornelius G., New York, NY
Coffin, Rockwell C., Boston, MA
Cox, Gerald H., New York, NY
Cushing, E. W., Boston, MA
Cutter, Ephraim, West Falmouth, MA
Daly, W. H., Pittsburgh, PA
Davis, F. H., Chicago, IL
Davis, Warren B., Philadelphia, PA
Dennis, Frank Lownes, Colorado Springs, CO
Dickerman, E. T., Chicago, IL
Dickinson, John T., Pittsburgh, PA
Donaldson, Frank, Baltimore, MA
1935
1919
1914
1901
1917
1897
1940
1909
1907
1940
1878
1913
2001
1905
1934
1995
1988
1933
1957
1878
1945
1879
1907
1882
1893
1938
1939
1901
1925
1878
1882
1938
1880
1878
1879
1960
1961
1944
1979
1964
Equen, Murdock S., Atlanta, GA
Eves, Curtis C., Philadelphia, PA
Faulkner, E. Ross, New York, NY
Fetterolf, George, Philadelphia, PA
Freeman, Walter J., Philadelphia, PA
Friedberg, Stanton A., Chicago, IL
Frothingham, Richard, New York, NY
Fuchs, Valentine H., New Orleans, LA
Getchell, Albert C., Worcester, MA
Gibb, Joseph S., Philadelphia, PA
Gill, William D., San Antonio, TX
Glasgow, William Carr, St Louis, MO
Goldstein, Max A., St Louis, MO
Gray, Steven D., Salt Lake City, UT
Grayson, Charles P., Philadelphia, PA
Grove, William E., Milwaukee, WI
Gussack, Gerald S., Atlanta, GA
Hanson, David G., Chicago, IL
Harkness, Gordon F., Davenport, IA
Harrill, James A., Winston-Salem, NC
Hartman, J. H., Baltimore, MD
Hickey, Harold L., Denver, CO
Holden, Edgar, Newark, NJ
Holmes, Christian R., Cincinnati, OH
Hooper, Franklin H., Boston, MA
Hope, George B., New York, NY
Hourn, George E., St Louis, MO
Hunt, Westley Marshall, New York, NY
Hyatt, Frank, Washington, DC
Iglauer, Samuel, Cincinnati, OH
Ingals, E. Fletcher, Chicago, IL
Ives, Frank L., New York, NY
Jackson, Chevalier L., Philadelphia, PA
Jarvis, William C., New York, NY
Johnson, Hosmer A., Chicago, IL
Johnson, Woolsey, New York, NY
Johnston, Kenneth C., Chicago, IL
Jones, Edley H., Vicksburg, MS
Jones, Marvin F., New York, NY
Kealhofer, R. H., St Louis, MO
99
Active Fellows
1954
1942
1901
1878
1965
1898
1880
1953
1878
1911
1913
1897
1935
1888
1919
1952
1915
1914
1881
1898
1948
1879
1927
1936
1913
1945
1885
1954
1958
1881
1950
1940
1886
1925
1914
1892
1881
1893
1895
1961
1927
1894
1892
1927
1954
1908
1882
1934
1902
1930
1945
1953
1881
Keim, W. Franklin, Montclair, NY
King, Edward D., North Hollywood, CA
King, Gordon, New Orleans, LA
Knight, Frederick Irving, Boston, MA
Knight, John S., Kansas City, MO
Kyle, D. Braden, Philadelphia, PA
Langmaid, Samuel W., Boston, MA
Lederer, Francis L., Chicago, IL
Lincoln, Rufus P., New York, NY
Lockard, Lorenzo B., Denver, CO
Loeb, Hanau W., St Louis, MO
Logan, James E., Kansas City, MO
Looper, Edward A., Baltimore, MD
Lowman, John H., Cleveland, OH
Lynah, Henry L., New York, NY
Lynch, Mercer G., New Orleans, LA
Lynch, Robert Clyde, New Orleans, LA
Mackenty, John E., New York, NY
Major, G. W., Montreal, Canada
Makuen, G. Hudson, Philadelphia, PA
Maxwell, James H., Ann Arbor, MI
McBurney, Charles, New York, NY
McGinnis, Edwin, Chicago, IL
McGregor, Gregor, Toronto, Canada
McKimmie, O. A., Washington, DC
McLaurin, John G., Dallas, TX
McSherry, Clinton II, Baltimore, MD
Meltzer, Philip E., Boston, MA
Montreuil, Fernand, Montreal, Canada
Morgan, E. C., Washington, DC
Morrison, Lewis F., San Francisco, CA
Morrison, William W., New York, NY
Mulhall, J. C., St Louis, MO
Mullin, William V., Cleveland, OH
Munger, Carl E., Waterbury, CT
Murray, T. Morris, Washington, DC
Mynter, H., Buffalo, NY
Newcomb, James E., New York, NY
Nichols, J. E. H., New York, NY
Ogura, Joseph H., St Louis, MO
Orton, Henry B., Newark, NJ
Park, William H., New York, NY
Porcher, W. Peyre, Charleston, SC
Porter, Charles T., Boston, MA
Pressman, Joel J., Los Angeles, LA
Randall, B. Alexander, Philadelphia, PA
Rankin, D. N., Allegheny, PA
Richards, Lyman G., Wellesley Hills, MA
Richardson, Charles W., Washington, DC
Ridpath, Robert E., Philadelphia, PA
Robb, James M., Detroit, MI
Roberts, Sam E., Kansas City, MO
Robertson, J. M., Detroit, MI
1879
1948
1922
1939
1935
1953
1913
1878
1879
1928
1893
1909
1878
1959
1892
1919
1909
1879
1932
1928
1911
1924
1934
1934
1879
1924
1903
1899
1892
1937
1967
1925
1970
1938
1888
1936
1954
1933
1896
1879
1886
1924
1924
1953
1939
1942
1922
1896
1940
Roe, John O., Rochester, NY
Whalen, Edward J., Hartford, CT
White, Francis W., New York, NY
Wilson, J. Gordon, Old Bennington, VT
Woodward, Fletcher D., Charlottesville, VA
Work, Walter, Green Valley, AZ
Roy, Dunbar, Atlanta, GA
Rumbold, T. F., St Louis, MO
Seiler, Carl, Philadelphia, PA
Shea, John Joseph, Memphis, TN
Shields, Charles M., Richmond, PA
Shurly, Burt R., Detroit, MI
Shurly, E. L., Detroit, MI
Silcox, Louis E., Punta Gorda, FL
Simpson, William Kelly, New York, NY
Skillern, Ross H., Philadelphia, PA
Sluder, Greenfield, St Louis, MO
Smith, Andrew H., Geneva, NY
Smyth, Duncan Campbell, Boston, MA
Sonnenschein, Robert, Chicago, IL
Staut, George C., Philadelphia, PA
Stein, Otto J., Chicago, IL
Stevenson, Walter, Quincy, IL
Suehs, Oliver W., Austin, TX
Tauber, Bernhard, Cincinnati, OH
Taylor, Hermon Marshall, Jacksonville, FL
Theisen, Clement F., Albany, NY
Thorner, Max, Cincinnati, OH
Thrasher, Allen B., Cincinnati, OH
Tobey, George L., Jr, Boston, MA
Trible, William M., Washington, DC
Tucker, Gabriel F., Sr, Philadelphia, PA
Tucker, Gabriel F., Jr, Chicago, IL
Vail, Harris H., Cincinnati, OH
Van der Poel, S. O., New York, NY
Voislawsky, Antonie P., New York, NY
Walsh, Theodore E., St Louis, MO
Wanamaker, Allison T., Seattle, WA
Ward, Marshall R., Pittsburgh, PA
Ward, Whitfield, New York
Westbrook, Benjamin R., Brooklyn, NY
Wherry, William P., Omaha, NE
White, Leon E., Boston, MA
Wilderson, William W., Nashville, TN
Williams, Horace J., Philadelphia, PA
Wishart, D. E. Staunton, Toronto, Canada
Wishart, David J. G., Toronto, Canada
Wollen, Green V., Indianapolis, IN
Wood, V. Visscher, St Louis, MO
100
ROSTER OF FELLOWS – 2011
Date indicates year admitted to active fellowship.
Active Fellows - 132
Year
Elected
1994
Abemayor, Elliot, M.D., Univ of California,
L.A. Rm. 62-132 CHS, 10833 Le Conte
Ave., Los Angeles CA 90095-1624
1974
Alford, Bobby R., M.D., Baylor College of
Medicine, One Baylor Plaza, #NA 102,
Houston TX 77030-3498
2006
Altman, Kenneth W., M.D., Ph.D., Dept of
Otolaryngology, Mt. Sinai School of
Medicine, One Gustave L. Levy Pl., Box
1189 New York, NY 10029
2008
Armstrong, William B., MD, 525 S. Old
Ranch Rd., Anaheim Hills, CA 92808-1363
2001
Aviv, Jonathan, M.D., Dept of
Otolaryngology, New York Presbyterian
Hospital, 180 Ft. Washington Ave., Suite
736, New York NY 10032
2010
Baredes, Soly, M.D., Univ of Medicine and
Dentistry of New Jersey, Dept. of
Otolaryngology, 90 Bergen St., Ste. 7200,
Newark, NJ 07103
1999
Benninger, Michael S., M.D., Dept. of
Otolaryngology, Henry Ford Hospital, 2799
West Grand Blvd., Detroit MI 48202-2689
1993
Berke, Gerald S., M.D., Div. of
Otolaryngology - Head & Neck Surgery,
UCLA School of Med., 10833 Le Conte,
Los Angeles CA 90095-0001
2007
Bielamowicz, Steven, M.D., Dept. of
Otolaryngology, Washington University
Hospital, 2150 Pennsylvania Ave. NE.,
Suite 6-301, Washington, DC 20037
1977
Blaugrund, Stanley M., M.D., 115 East 61st
Street, New York NY 10021
1987
Blitzer, Andrew, M.D., D.D.S., 425 W. 59th
St., 10th Fl., New York NY 10019
1984
Bone, Robert C., M.D., 10666 No. Torrey
Pines Road, La Jolla CA 92037
1994
Broniatowski, Michael, M.D., 2351 East
22nd St., Cleveland OH 44115
2011
Burns, James A., M.D., Harvard Medical
School MA General Hospital, Dept. of
Otolaryngology, One Bowdoin Square, 11th
Floor, Boston, MA 02114
1994
Caldarelli, David D., M.D., Dept. of
Otolaryngology, Rush Presbyterian St.
Luke’s Medical Center, 1653 West Congress
Parkway, Chicago IL 60612
1985
Canalis, Rinaldo F., M.D., 457 15th St.,
Santa Monica CA 90402
2006
Carrau, Richard L, M.D., St. John’s Health
System, BTC, 2121 Santa Monica Blvd.,
Santa Monica, CA 90404
1994
Cassisi, Nicholas J., D.D.S., M.D., Health
Sciences Center, P.O. Box 100264,
Gainesville FL 32610-0264
2011
Chhetri, Dinesh, M.D., UCLA School of
Med., Div. of Otolaryngology – Head &
Neck Surgery, 10833 Le Conte Los Angeles
CA 90095-0001
1993
1992
1988
2002
1984
1980
2011
1995
2003
2002
2003
1982
1995
2010
1990
2011
Close, Lanny G., M.D., Dept. of
Otolaryngology, Columbia University, 622 W
168th Street, New York NY 10032-3702
Cotton, Robin T., M.D., Dept. of Pediatric Oto
and Maxillofacial Surgery, Children’s Hospital
Med. Ctr. ASB-3, 3333 Burnet Ave.,
Cincinnati OH 45229-2899
Coulthard, Stanley W., M.D., 1980 W.
Hospital Dr., Ste. 111, Tucson AZ 85704
Courey, Mark S., M.D., UCSF Voice
&
Swallowing Center, 2330 Post St, 5th
Floor, San Francisco, CA 94115
Crumley, Roger L., M.D., M.B.A., Head &
Neck Surgery, UC Irvine Medical Center,
101 City Drive South, Bldg. 25, Orange CA
92868
Cummings, Charles W., M.D., Dept. of
Otolaryngology–Head and Neck Surgery,
Johns Hopkins School of Medicine, 601 N.
Caroline St., Baltimore MD 21287
Dailey, Seth, MD, Medical College of
Wisconsin, Div. of Oolaryngology – 600
Highland Ave., K4/719 CSC, Madison, WI
53792
Donald, Paul J., M.D., Dept. of
Otolaryngology, Univ of California Davis,
2521 Stockton Boulevard, Sacramento CA
95817
Donovan, Donald T., M.D., Baylor College of
Medicine, One Baylor Plaza, SM 1727,
Houston TX 77005
Drake, Amelia F., M.D., Div. of
Otolaryngology–Head & Neck Surgery, UNC
School of Medicine CB #7070, 610 BurnettWomack Bldg., Chapel Hill NC 27599-7070
Eisele, David W., M.D., Dept. of
Otolaryngology- Head & Neck Surgery, Univ
of California San Francisco, 400 Parnassus
Ave., Suite A730, San Francisco, CA 941430342
Fee, Willard E. Jr., M.D., Div of
Otolaryngology –Head & Neck Surgery,
Stanford University Medical Center, , 875
Blake Wilbune Dr., CC-2227, Stanford CA
94305
Fisher, Samuel R., M.D., Dept of
Otolaryngology, Duke University Medical
Center, P O Box 3805, Durham NC 27710
Flint, Paul W., MD Univ. of Oregon Health
Sciences Center, Dept. of Otolaryngology,
3181 SE Sam Jackson Park Rd., (PV01),
Portland, OR 97239
Ford, Charles N., M.D., UW-CSC, H4/320,
600 Highland Avenue, Madison WI 53792
Franco, Ramon Jr. MD, MA General Hospital
Dept. of Otolaryngology, 243 Charles St., 7th
Floor, Boston, MA 02114
101
1989
1995
2002
1999
1985
2000
2011
1991
1998
2008
1983
2009
1997
1998
2007
1986
1994
1998
1996
1983
1990
Fried, Marvin P., M.D., Montefiore Med
Ctr., Green Med Arts Pavilion, 3400
Bainbridge Ave., 3rd Fl., Bronx NY 104672404
Friedman, Ellen M., M.D., Dept. of
Otolaryngology, Texas Children’s Hospital,
6621 Fannin Street, Houston TX 77030
Garrett, C. Gaelyn, M.D., VUMC Dept. of
Otolaryngology, 7302 MCE South,
Nashville TN 37232-8783
Goding, George S. Jr., M.D., Dept. of
Otolaryngology–HNS, Hennepin County
Medical Center, 701 Park Ave., Minneapolis
MN 55414
Goode, Richard L., M.D., Dept. of OTO,
R135, Stanford Univ Med Ctr., 300 Pasteur
Dr., Palo Alto CA 94304
Goodwin, W. Jarrard Jr., M.D., 9841 W.
Suburban Dr., Miami FL 33156
Gourin, Christine, MD, John Hopkins Med.
Center, Dept. of Otolaryngology 601 N.
Caroline St., #6260A, Baltimore, MD 21287
Gullane, Patrick J., M.D., Toronto General
Hospital, 200 Elizabeth Street EN 7-242,
Toronto, Ontario M5G 2C4, CANADA
Har-El, Gady, M.D., Division of HHS, Long
Island College Hospital, 134 Atlantic Ave.,
Brooklyn, NY 11201
Hayden, Richard E., MD, Mayo Clinic –
Scottsdale, Dept of Otolaryngology, 5777 E.
Mayo Blvd., #18, Scottsdale, AZ 85255
Healy, Gerald B., M.D., Children’s Hospital,
300 Longwood Ave., #5, Boston MA
02115-5747
Heman-Ackah, Yolanda, MD, Philly ENT,
Inc., 1721 Pine St., Philadelphia, PA 19103
Herzon, Fred S., M.D., Dept of
Otolaryngology, Univ. of New Mexico,
2211 Lomas NE, Albuquerque NM 871315431
Hillel, Allen D., M.D., Univ of Washington,
Dept. of Otolaryngology, Box 356515,
Seattle, WA 98195
Hoffman, Henry T. M.D., Dept. of
Otolaryngology, University of Iowa
Hospitals and Clinics, 200 Hawkins Drive.,
Iowa City, IA 52242
Holinger, Lauren D., M.D., Dept. of Otolaryngology, Children’s Memorial
Hospital, 2300, Children’s Plaza, Box 25,
Chicago IL 60614
Holt, G. Richard, M.D., Dept. of OTO, Univ
of TX – San Antonio, 7703 Floyd Curl Dr.,
MC7777, San Antonio, TX 78258
Hoover, Larry A., M.D., Dept. of OTO,
Univ of KS School of Med Ctr., 3901
Rainbow Blvd., Kansas City KS 661607380
Jafek, Bruce, M.D., Dept. of
Otolaryngology, Univ of Colorado, School
of Medicine, 4200 East 9th Ave, B-205,
Denver CO 80220
Johns, Michael E., M.D., Emory University,
1648 Pierce Dr., Ste 367, Atlanta GA 30322
Johnson, Jonas T., M.D., Dept. of
Otolaryngology, Eye & Ear Hospital, Suite
500, 200 Lothrop Street, Pittsburgh PA
15213
2002
1998
1999
2000
2009
1993
2011
1991
2006
2011
1981
2000
1987
1996
1987
1996
1988
1996
1989
1996
1993
2007
1997
Keane, William M., M.D., Dept of
Otolaryngology, 925 Chestnut St., 6th Fl.,
Philadelphia PA 19107
Kelly, James H., M.D., Greater Baltimore Med
Ctr., 6635 N. Charles St., Rm. 250, Baltimore,
MD 21204
Kennedy, David W., M.D., Univ of
Pennsylvania Medical Center, 3400 Spruce St.,
Philadelphia, PA 19104-4274
Kennedy, Thomas L., M.D., 100 N. Academy
Ave, Danville PA 17822
Kerschner, Joseph MD, Children’s Hospital of
Wisconsin, Dept of Otolaryngology, 9000
Wisconsin Av., Milwaukee, WI 53226
Komisar, Arnold, M.D., D.D.S., 1317 Third
Avenue, 8th Floor, New York NY 10021
Kost, Karen M. MD, Montreal General
Hospital, Dept. of Otolaryngology, 1650 Cedar
St., Montreal, Quebec, H3G 1A4, Canada
Koufman, Jamie A., M.D.,
Voice Institute of
New York, 200 W. 57th St., Ste 1203 New
York, NY 10019
Kraus, Dennis H., M.D., Memorial SloanKettering Cancer Center, 1275 York Ave.,
New York, NY 10021
Lavertu, Pierre, MD, Univ. Hospital, Case
Medical Ctr., Dept of Otolaryngology, 11100
Euclid Ave., Cleveland, OH 44106
Lawson, William, M.D., Dept. of
Otolaryngology, Mount Sinai School of
Medicine, One Gustave L. Levy Place, New
York NY 10029
Levine, Paul A., M.D., Univ of Virginia
Health Systems, Dept. of OTO, MC #800713,
Rm. 277b, Charlottesville VA 22908
Lucente, Frank E., M.D., Dept. of
Otolaryngology, Long Island College Hosp.,
339 Hicks St., Brooklyn NY 11201
Lusk, Rodney P., M.D., Dept. of
Otolaryngology, Boys Town National
Research Hospital, 555 North 30th St, Omaha,
NE 68131
Maisel, Robert H., M.D., 8721 Westmoreland
Lane, Minneapolis MN 55426
Maragos, Nicholas E., M.D., Mayo Clinic, 200
First St. SW, Rochester MN 55905
Mathog, Robert H., M.D., 27117 Wellington
Rd., Franklin MI 48025
Maves. Michael D., M.D., MBA, American
Medical Association, 615 N. State St.,
Chicago, IL 60610
McCaffrey. Thomas V., M.D., Ph.D., Dept of
Otolaryngology-HNS, Univ. of S. Florida,
12902 Magnolia Dr., Ste. 3057, Tampa FL
33612
McGill, Trevor J.I., M.D., CHMC
Otolaryngologic Foundation, Inc., 300
Longwood Ave., Boston, MD 02115
Medina, Jésus E., M.D., F.A.C.S., Dept. of
Otorhinolaryngology, The University of
Oklahoma, P.O. Box 26901, WP 1290,
Oklahoma City OK 73190-3048
Merati, Albert L. M.D., Div. of
Otolaryngology, Medical College of
Wisconsin, 9200 W. Wisconsin Ave.,
Milwaukee, WI 53226
Metson, Ralph, M.D., Zero Emerson Place,
Boston MA 02114
102
1987
2008
1986
1979
2007
1994
1980
1986
1995
2005
1990
1990
2004
1988
1999
1998
1989
1997
2010
Miller, Robert H., M.D., 5615 Kirby Drive,
Suite 600, Houston, TX 77005
Mirza, Natasha , M.D., Hospital of the
University of Pennsylvania, 3400 Spruce St.,
5 Silverstein, Philadelphia, PA 19104
Morrison, Murray D., M.D., 4th Floor
Willow Pavilion, Vancouver General
Hospital, 805 W. 12th Street, Vancouver,
BC, V5Z 1M9 CANADA
Myers, Eugene N., M.D., Univ of Pittsburgh
School of Med., Eye and Ear Institute, Ste.
500, 230 Lothrop St., Pittsburgh, PA 15212
Myssiorek, David M.D., University of
Pittsburgh School of Medicine, Eye & Ear
Institute, Suite 500, 230 Lothrop St.,
Pittsburgh. PA 15212-2598
Netterville, James L., M.D., VUMC Dept of
Otolaryngology, 7209 MCE South,
Nashville TN 37232-8605
Nichols, Richard D., M.D., 12801 Grand
Transverse Dr., Dade City, FL 33525-8231
Noyek, Arnold M., M.D., Dept. of
Otolaryngology, Mount Sinai Hospital, 600
University Avenue, Suite 401, Toronto,
Ontario, M5G 1X5, CANADA
Olsen, Kerry D., M.D., Dept. of
Otolaryngology, Mayo Medical Center, 200
First Street SW, Rochester MN 55905-0001
O’Malley, Bert W., M.D., Dept of
Otolaryngology, Univ. of Pennsylvania
Health System, 3400 Spruce Street, 5
Ravdin, Philadelphia, PA 19104
Osguthorpe, John D., M.D., Dept. of
Otolaryngology and Communicative
Sciences, Med Univ. of SC, St. Francis
Annex, Rm. 207, 150 Ashley Ave.,
Charleston SC 29401
Ossoff, Robert H., D.M.D., M.D., VUMC
Dept. of Otolaryngology, 7302 MCE South,
Nashville TN 37232-8783
Paniello, Randal C., M.D., Dept of
Otolaryngology, Washington University
School of Medicine, 660 S. Euclid, Campus
Box 8115, St. Louis MO 63110
Panje, William R., M.D., University Head &
Neck Associates, Rush Presbyterian St.
Luke’s Med Ctr., 1725 West Harrison
Street, Suite 340, Chicago IL 60612
Parnes, Steven M., M.D., Div. of
Otolaryngology, Albany Med. Ctr., MC 41,
47 New Scotland Ave., Albany, NY 122083412
Persky, Mark S., M.D., Beth Israel Med
Ctr., 10 Union Sq E, New York NY 10003
Pillsbury, Harold C. III, M.D., Div. of
Otolaryngology–Head & Neck Surgery,
UNC-Chapel Hill, CB #7070, 1115
Bioinformatics Bldg, Chapel Hill NC
27599-7070
Potsic, William P., M.D., Div. of
Otolaryngology, The Children’s Hospital of
Philadelphia, 34th Street & Civic Center
Blvd., Philadelphia PA 19104
Rahbar, Reza MD, Children’s Hospital of
Boston, Dept. of Otolaryngology, 300
Longwood Ave., LO367, Boston, MA
02115
1995
1985
1992
1995
1982
1995
2005
1997
1981
1995
1992
1992
1987
2009
2008
1983
1990
1997
2009
2009
1995
1979
Reilly, James S., M.D., Dept. of
Otolaryngology, Nemours-duPont Hospital for
Children, 1600 Rockland Road, PO Box 269,
Wilmington DE 19899
Rice, Dale H. M.D., Ph.D., Univ. of Southern
California, Health Consultation Center II,
1510 San Pablo St., Ste. 4600, Los Angeles
CA 90033
Richtsmeier, William J., M.D., Ph.D., Bassett
Healthcare, 1 Atwell Rd., Cooperstown NY
13326
Robbins, K. Thomas, M.D., Div. of OTO,
Southern Illinois University
School of
Medicine, 301 N 8th St., Room 5B-501,
Springfield, IL 62701
Rontal, Eugene, M.D., 28300 Orchard Lake
Rd., Farmington MI 48334
Rontal, Michael, M.D., 28300 Orchard Lake
Rd., Farmington MI 48334
Rosen, Clark A., M.D., Eye & Ear Institute,
200 Lothrop Street, Ste 500, Pittsburgh, PA
15213-2546
Ruben, Robert J., M.D., Montefiore Medical
Ctr., 3400 Bainbridge Ave, 3rd Fl, Bronx NY
10467
Sasaki, Clarence T., M.D., OTO Dept of
Surgery, Yale University School of Med, PO
Box 208041, New Haven CT 06520
Sataloff, Robert T. , M.D., D.M.A., 1721 Pine
Street, Philadelphia PA 19103-6701
Schaefer, Steven D., M.D., Dept. of ORL,
New York Eye and Ear Infirmary, 14th Street
at 2nd Avenue, New York NY 10003
Schechter, Gary L., M.D., 120 Cardinal Lane,
Cardinal VA 23025
Schuller, David E., M.D., 300 W. 10th Ave.,
Ste. 519, Columbus OH 43210
Schweinfurth, John M. MD, Univ. of
Mississippi, Dept. of Otolaryngology 2500 N.
State, Jackson, MS 39912
Schweitzer, Vanessa G., MD, 28738 Hidden
Trail, Farmington Hill, MI 48334
Session, Roy B., M.D., Dept. of Otolaryngology–Head and Neck Surgery, Beth Israel Med
Ctr., 10 Union Sq. E, Ste 4J, New York NY
10003
Shapshay, Stanley M., M.D., University Ear,
Nose & Throat, Albany Medical Center, 35
Hackett Blvd., Albany, NY 12208-3420
Shockley, William W., M.D., Dept. of
Otolaryngology, Univ. of NC – Chapel Hill.,
G-0412 Neurosciences Hospital, CB 7070,
Chapel Hill NC 27599-7070
Simpson C. Blake, MD. Univ. of Texas – San
Antonio, Dept of Otolaryngology 7703 Floyd
Curl Dr., MSC 7777, San Antonio, TX 78229
Smith, Marshall E., MD, Univ. of Utah, Dept
of Otolaryngology 50 N. Medical Dr., 3C120,
Salt Lake City, UT 84132
Sofferman, Robert A., M.D., Div. of
Otolaryngology, Fletcher Allen Health Care,
West Pavilion 4, 111 Colchester Ave.,
Burlington VT 05401
Spector. Gershon J., M.D., Dept. of
Otolaryngology, Washington Univ School of
Med, 517 S. Euclid, St. Louis MO 63110
103
1991
2006
1997
2010
2004
1982
2008
1979
1973
2004
1996
2003
Strome, Marshall, M.D., Dept.
of
Otolaryngology, 110 East 59th St., 10th
Floor, New York, NY 10022
Strome, Scott E., M.D., Dept of
Otolaryngology, Univ. of Maryland Medical
Center, 16 S. Eutaw St., Suite 500,
Baltimore, MD 21201
Stucker, Frederick J., M.D., Louisiana State
University Med., Dept. of Otolaryngology,
1501 Kings Hwy. #33932, Shreveport LA
71103-4228
Sulica, Lucian, MD, Weil-Cornell Medical
College, Dept.
of Otolaryngology, 1305
York Ave., 5th Floor, New York, NY 10021
Terris, David J., M.D., 4 Winged Foot
Drive, Martinez, GA 30907
Thawley, Stanley E., M.D., Washington
Univ School of Med, 517 S. Euclid Avenue,
St. Louis MO 63110
Thompson, Dana M., M.D., M.S., Mayo
Clinic, Dept. of OtolaryngologyGonda 12
South, 200 First St. SW, Rochester, MN
55905
Tucker, Harvey M., M.D., 3 Louis Drive,
Pepper Pike, OH 44124
Tucker, John A., M.D., 4040 D une Dr.,
Avalon, NJ 08202
Varvares, Mark A., M.D., 3635 Vista @
Grand, FDT-6, St. Louis,, MO 63110
Weber, Randal S., M.D., Univ of Texas,
Dept of Otolaryngology – HNS, Unit 441,
1515 Holcombe Blvd., Houston, TX 77030
Weinstein, Gregory S., M.D., Dept. of
Otorhinolaryngology –Head & Neck
1991
1997
1995
1994
1997
1989
1996
1994
1981
1995
Surgery, Univ of Pennsylvania, 3400 Spruce
St., 5 Ravdin, Philadelphia, PA 19104-4283
Weisberger, Edward C. M.D., Indiana Univ
Med Ctr., Rm. 0860, 702 Barnhill Drive,
Indianapolis IN 46202-5230
Weisman, Robert A., M.D., Div. of ORL–
Head & Neck, UCSD Medical Center, 200 W.
Arbor Dr., San Diego CA 92103-9891
Weissler, Mark C., M.D., Div. of
Otolaryngology, Univ. of NC – Chapel Hill,
G-0412 Neurosciences Hospital, CB 7070,
Chapel Hill NC 27599-7070
Wenig, Barry L., M.D., Dept. of OTO,
Evanston Northwestern Hosp., 1000 Central
St., Ste. 610, Evanston IL 60201
Wetmore, Ralph F., M.D., Div. of
Otolaryngology, The Children’s Hospital of
Philadelphia, 34th St. & Civic Center Blvd.,
Philadelphia PA 19104
Weymuller, Ernest A. Jr., M.D., Dept. of
Otolaryngology–Head & Neck Surgery, Univ.
of Washington Medical Ctr., PO Box 356515,
Seattle WA 98195-0001
Woo, Peak, M.D., Peak Woo, MD, PLLC,
300 Central Park West., New York, NY 10024
Woodson, Gayle E., M.D., Div. of OTO,
Southern Illinois University
School of
Medicine, 301 N 8th St., Room 5B-501,
Springfield, IL 62701
Yanagisawa, Eiji, M.D., University Tower, 98
York Street, New Haven CT 06511-5620
Zeitels, Steven M., M.D., Dept. of
Otolaryngology, Massachusetts Gen. Hospital,
One Bowdoin Sq., Boston, MA 02114
Associate Fellows – 5
1996
1997
1992
Bless, Diane , Ph.D., Dept of
Otolaryngology, Univ. of Wisconsin
Hospital, CHS F4/217, 600 Highland Ave.,
Madison, WI 53792
Hillman, Robert E., PhD., Dept. of
Otolaryngology, Massachusetts General
Hospital, One Bowdoin Sq., Boston, MA
02114
Ludlow, Christy L., PhD, National Institute
of Health, 10 Center Dr., MSC 1416,
Bethesda, MD 20892
2006
2006
Murry, Thomas, PhD, Dept of
Otolaryngology, Columbia Presbyterian
Medical Center, 180 Ft. Washington Ave.,
HP 8-812, New York, NY 10032-3710
Thibeault, Susan L., PhD, Dept. of
Otolaryngology, Univ. of Utah School of
Medicine, 50 N. Medical Drive, Rm 3-C120, Salt Lake, UT 84132
Honorary Fellows -3
1991(1963) Kirchner, John A., MD, 12 Rimon Hill
Rd., Woodbridge, CT 06525-1234
1995 (1974) Snow, James B., Jr., MD, PhD, 327
Greenbrier Lane, West Grove, PA
19390-9490
1999
Titze, Ingo R., PhD, The University of
Iowa, 330 WJSHC, Iowa City, IA
52242-1012
Corresponding Fellows - 49
1999
1991
Abitbol, Jéan, M.D., ENT Laser Surgery, 1
Rue Largilliere, Paris, 75010 FRANCE
Andrea, Mario, M.D., Av. Egas Moniz,
1649-035, 1000 - Lisbon, PORTUGAL
1999
Antonelli, Antoninoi, M.D., Univ. of
Brescia, P.LI Spedali Ciuili 1 Brescia,
25100 ITALY
104
1980
1991
1995
1995
1995
Benjamin, Bruce, M.D., 19 Prince Road,
Killara, NSW, 2071, AUSTRALIA
Bradley, Patrick J., M.D., 37 Lucknow
Drive, Nottingham NG3 2UH,
ENGLAND1993 Brasnu, Daniel F., M.D.,
EHGP Dept of OTO, 20 Rue Leblanc,
75908 Paris, FRANCE
Bridger, G. Patrick, M.D., 1/21 Kitchener
Place, Bankstown 2200 NSW,
AUSTRALIA
Campora, Enrico de, M.D., Ph.D., Dept of
ORL, Policlinicio di Careggi, Viale
Morgagni 85, Florence 50134 ITALY
Coates, Harvey LC, MB, 208 Hampden
Road, Nedlands 6009, Perth, AUSTRALIA
1998
1988
2003
1993
2010
1995
2003
1984
1986
1986
2003
1996
1994
1995
1984
1991
1999
1993
1988
Coman, William B., M.B., The Univ. of
Queensland, ENT Department, Princess,
Alexandra Hospital, Ipswich Road,
Woolloongabba QLD 4102, AUSTRALIA
Eckel, Hans E., M.D., Dept. of
Otorhinolaryngology, Univ of Cologne,
LKH Klagenfurt St., Veiter Str 47,
Klagenfurt A-9020 AUSTRIA
Evans, John N.G., M.D., 5 Lancaster Ave.,
London, SE77 ENGLAND
Ferlito, Alfio , M.D., Dept. of Scienze
Chirurgiche, Piazzale Santa Maria della,
Misericordia, Udine 33100, ITALY
Fonseca, Rolando, M.D., Universidad de
Buenos Aires, Facultad de Medicina,
Hospital de Clinicas, La Rioja 3920, La
Lucila 1636, Buenos Aires, ARGENTINA
Friedrich, Gerhard, M.D., Dept. of
Phoniatrics and Speech Pathology, ENTHospital Graz, A-8036 Graz
Auenbruggerplatz 2628, AUSTRIA
Glanz, Katharine Hiltrud, M.D., Klinikum
der Justus-Liebig-Universitat Gieben,
Feulgenstable 10, D35385 Giessen,
GERMANY
Gregor, Reinhold T., M.B., B.Ch., Dept
ORL, Univ. of Stellenbosch, P O Box
19063, Tyersberg, 7505 SOUTH AFRICA
Hasegawa, Makoto, M.D., Ph.D., Dept of
Sleep Related Respiratory Disorders, Tokyo
Medical & Dental University, 1-5-45
Yushima, Bunkyoku, Tokyo, 6202 JAPAN
Hirano, Minoru, M.D., Dept. of
Otolaryngology - Head and Neck Surgery,
Kurume University, 242-5 Nishimachi, ,
Kurume 830-0038, JAPAN
Hisa, Yasuo, M.D., Ph.D., Dept. of
Otolaryngology, Kyoto Prefectural
University of Medicine, KawaramachiHirokoji, Kyoto 602-8566, JAPAN
Hosal, I. Nazmi, M.D., Mesrutlyet Cadesi,
No. 29/13 Yenisehir, Ankara, TURKEY
Howard, David J., F.R.C.S., F.R.C.S.E.D.,
Dept of Otorhinolaryngology, Royal Natl
TNE Hosp., 330 Gray’s Inn Road, London,
WC1X 8DA, ENGLAND
Isshiki, Nobuhiko, M.D., Isshiki Clinic,
Kyoto University 3F, 18-1 Unrin-in-cho
Murasakino Kitaku Kyoto, 603 Kyoto,
JAPAN
1985
2005
2005
2000
2005
1964
1997
1998
1999
2005
1996
2010
2001
2011
2001
Kim, Kwang Hyun, M.D., Ph.D., Seoul
Nat’l. Univ. Hospital Dept of
Otolaryngology, 28 Yongon-Dong, Congnogu, Seoul 110-744, KOREA
Kim, Kwang-Moon, M.D., Dept. of
Otolaryngology, Yonsei University College
of Medicine, Yongdong Severeance
Hospital, 146-92 Dogok-dong KangnamFU, Seoul, 135-720 KOREA
Mahieu, Hans F., M.D., Dept of
Otolaryngology, University Hospital VU, P
O Box 7057, 1007 MB Amsterdam, THE
NETHERLANDS
Mann, Wolf J. M.D., University of HNOKunik, Lagenbeck-Str 1, Mainz,
GERMANY 55101
Maune, Steffen, MD, PhD. HNO-Klinik,
Neufeder Str. 32, Doln, 51067, GERMANY
Murakami, Yasushi, M.D., Ryoanji, 4-2
Goryoshita, U-KYO-KU, Kyoto, 616
JAPAN
Nakashima, Tadashi, M.D., Kurume Univ.
School of Medicine, OTO Dept., 67 Asahimachi, Kurme, 830-0011 JAPAN
Nicolai, Perio, M.D., University of Brescia
Dept of Otorhinolaryngology, Via Corfu 79,
Brescia, 25100 ITALY
Omori, Koichi, M.D., Ph.D., Fukushima
Med. Univ. Dept of Otolaryngology, 1
Hikarigaoka, Fukushima 960-1295 JAPAN
Peretti, Giorgio, M.D., Univ. Degli Studi Di
Brescia, OTO Clinica Via Dabbeni 91 A,
25100 Brescia, ITALY
Perez, Alfredo C., M.D., Institito Celis
Perez, Avenida Montes Deoca, Valencia,
VENEZUELA, S.A.
Perry, Christopher F., M.B.B.S., 4th Floor,
Watkins Medical Center, 225 Wickham
Terrace, Brisbane, QLD, AUSTRALIA
4000
Remacle, Marc, M.D., Ph.D., ENT Dept.,
Cliniques Univ de Mont-Godin, Avenue Dr
Therasse 1 B-5530 Yvoir, BELGIUM
Repassy, Gabor, M.D., Chazar A U 15,
Budapest, HUNGARY 1146
Rinaldo, Alessandra, M.D., Dept. of
Surgical Sciences, ENT Clinic, Univ. of
Udine, Policlinicio Universitario, Piazzale S.
Maria della Misericordia, 33100 Udine,
ITALY
Rudert. Heinrich H., M.D., Professor &
Chairman, Klinikum der ChristianAlbrechts-, Universitat zu Kiel, ArnoldHeller-Strabe 14, 24105 Keil, GERMANY
Sandhu, Guri, MBBS, Royal National TNE
and Charing Cross Hospitals, 107 Harley
St., London, W1G 6AL, ENGLAND
Sato, Kiminori, M.D., Ph.D., Dept of
Otolaryngology, Kurume Univ. School of
Medicine, 67 Asahi-nacgu, Kurume 8300011 JAPAN
Shionati, Akihiro, MD, PhD. National
Defense Medical College, Dept. of
Otolaryngology 302 Namiki, Tokorozawa,
Saitama, 359-8513, JAPAN
Steiner, Wolfgang, M.D., Univ. of
Gottingen Dept of Otolaryngology, Robert-
105
1991
1987
2002
Koch-Str. 40 Goettingen, 37099
GERMANY
Thumfart, Walter F., M.D., Univ HNO-KL
Anichst 35, Innsbruck Tyrol 6020,
GERMANY
Tu, Guy-yi, M.D., Dept. of Head & Neck
Surgery, Cancer Hospital, P.O. Box 2258,
Chaoyangqu Bejing, PEOPLES REPUBLIC
OF CHINA
2008
Werner, Jochen, M.D., Dept of OTO, Univ
of Marburg, Deutschhausstr 3, 35037
Marburg, GERMANY
1999
1995
Vokes, David E., M.D., Dept of
Otolaryngology, North Shore Hospital,
Private Bag 93-503, Takapuna, North Shore
City, 0740, NEW ZEALAND
Wei, William I., M.D., Dept. of Surgery Rm
206, Prof Bldg. Queen Mary Hosp., HONG
KONG
Wustrow, Thomas P.U., M.D., HNOGemeinschafts-Praxis, ittelsbacherplatz1/11
(ARCO - Palais) Munich, GERMANY
80333
Emeritus Fellows - 59
2001 (1987)
1984 (1969)
1984 (2008)
2006 (1975)
1988 (1970)
1989 (1963)
2001 (1975)
2005 (1988)
1992 (1975)
2003 (1995)
1988 (1959)
1996 (1976)
2006 (1979)
2002 (1976)
1995 (1985)
1989 (1967)
1993 (1971)
Adkins, Warren Y. Jr., M.D., 1187
Farm Quarter Rd., Mt. Pleasant SC
29464
Ausband, John R., M.D., 138 Boxwood
Rd, Aiken, SC 29803-6596
Applebaum, Edward L., M.D., 161
East Chicago Ave., Apt. # 42B,
Chicago, IL 60611
Bailey, Byron J., M.D., 2954
Dominique Dr., Galveston TX 775511571
Ballenger, John J., M.D., 660 Winnetka
Mews, Winnetka IL 60093-1968
Baxter, James D., M.D., 909 Ave du
Lac Saint-Savenr, Que J0R 1M1,
CANADA
Biller, Hugh F. , M.D., 215 Ocean
Ave., Wells ME 04090
Birt, B. Derek, M.D., Sunnybrook
Medical Centre, Rm. A208, 2075
Bayview Avenue, Toronto, Ontario,
M4N 3M5 CANADA
Boles, Roger, M.D., PO Box 620203,
Redwood City CA 94062
Brandenburg, James H., M.D., 5418
Old Middleton Rd, Apt. # 204,
Madison, WI 53705-2658
Brewer, David W., M.D., 211
Lafayette Road, #504, Syracuse NY
13205
Briant, Thomas D.R., M.D., 32 Dale
Ave., Toronto, Ontario M4W 1WB,
CANADA
Calcaterra, Thomas C., M.D., UCLA
2499 Mandeville Canyon. Road, Los
Angeles CA 90049
Cantrell, Robert W. Jr., M.D., 1925
Owensville Rd, Charlottesville VA
22901
Chodosh, Paul L., M.D., P.O. Box 406,
Oquossoc ME 04964
Cocke, Edwin W. Jr., M.D., 920
Madison Ave., Ste. 1030, Memphis TN
38103
Cohen, Seymour R., M.D., 4301
Cromwell Avenue, Los Angeles CA
90027
1973 (2011) Dedo, Herbert H., M.D., Dept. of
Otolaryngology, Univ of California Med.
Ctr., 350 Parnassus Avenue, Suite 501,
San Francisco CA 94117
2001 (1984) DeSanto, Lawrence W., M.D., 11750 E.
Charter Oak Dr., Scottsdale AZ 85259
1993 (1976) Doyle, Patrick John, M.D., 301-5704
Balsam Street, Vancouver, B.C., V6M
1Y6, CANADA
1993 (1973) Duvall, Arndt J. III, M.D., 2550
Manitou Island, St. Paul, MN 55110
2004 (2004) Eliachar, Isaac, M.D., 73513 Spyglass
Dr., Indian Wells, CA 92210
1992 (1968) Farrior, Richard T., M.D., 505 DeLeon
Street #5, Tampa FL 33606
1988 (1970) Frazer, John P., M.D., 329 Orchard
Park Boulevard, Rochester NY 14609
2002 (1977) Frederickson, John M., M.D.,
Washington Univ School of Med.,
Dept. of OTO, 517 S. Euclid Ave., Box
8115, St. Louis MO 63110
1988 (1977) Gacek, Richard R., M.D., Div. of
Otolaryngology, Univ. of MA., 55
Lake Avenue North, Worcester, MA
01655
2003 (1981) Gates, George A., M.D., Dept. of
OTO-HNS, Univ of WA Med Ctr., PO
Box 357923, Seattle WA 98195
1991 (2010) Gluckman, Jack L., M.D., Dept. of
Otolaryngology and Maxillofacial Surgery,
Univ of Cincinnati Medical Center, 231
Bethesda Avenue #0528, Cincinnati OH
45267-0528
2002 (1983) Goldstein, Jerome C., M.D., 4119
Manchester Lake Dr., Lake Worth FL
33467
2006 (1985) Gross, Charles W., M.D., Dept. of
Otolaryngology, Univ. of Virginia
Health Sciences Center, PO Box
800713, Charlottesville VA 22908
1996 (1987) Hawkins, Donald B., M.D., 78020
Ravencrest Circle, Palm Desert CA
92211-1258
2002 (1983) Hicks, Julius N., M.D., 3024 Cherokee
Rd., Birmingham AL 35223
1977 (1957) Holmes, Edgar M., M.D., Post Office
Box 121, S. Orleans MA 02662-0121
106
1997 (1974)
2000 (1983)
2001 (1985)
1991 (1975)
Hudson, William R., M.D., 21
Glenmore Drive, Durham, NC 27707
Jako, Geza J., M.D., 169 E. Emerson
St., Melrose MA 02176
Kashima, Haskins K., M.D., 3943
Canterbury Rd., Baltimore MD 21218
Kirchner, Fernando R., M.D., 6860
North Terra Vista, Tucson AZ 85750
1979 (2003)
1990 (1979)
2022 (1989)
Krause, Charles J., M.D., 880 Sea Dune
Lane, Marco Island, FL 34145-1840
LeJeune, Francis E., M.D., 334 Garden
Rd., New Orleans LA 70123
Maniglia, Anthony, MD, 11100 Euclid
Ave., Cleveland, OH 44106
107
1999 (1990)
1990 (2011)
1991 (1976)
1981 (2008)
1992 (1972)
2002 (1978)
1990 (1979)
1990 (1975)
1990 (1975)
2002 (1979)
Marsh, Bernard R. MD, 4244 Mt.
Carmel Rd., Upperco, MD 21155
McGuirt, W. Frederick Sr. MD, 901
Goodwood Rd., Winston-Salem, NC
27106
Miglets, Andrew W. Jr., MD, 998
Sunbury Rd., Westerville, OH 43082
Neel, H. Bryan III, MD, PhD, 828
Eighth St SW, Rochester, MN 55902
Pennington, Claude L. MD, P. O. Box
1916, 800 First St., Macon, GA 31202
Sessions, Donald G., M.D., 1960
Grassy Ridge Rd., St. Louis MO 63122
Shapiro, Myron J., M.D., Sand Spring
Road Morristown NJ 07960
Sprinkle, Philip Martin, M.D., 315
Hospital Dr., Ste 108, Martinsville VA
24112-8806
Strong, M. Stuart, M.D., 10 Byrsonima
Loop West, Homosassa FL 34446
Tardy, M. Eugene, M.D., 225 N.
Kenilworth Ave., Unit L, Oak Park, IL
60302
2002 (1982)
1988 (2006)
1991 (1967)
1989 (1964)
1989 (2011)
2002 (1984)
2003 (1980)
2000 (1974)
1983 (1971)
Olson, Nels R., MD, 2178 Overlook
Ct., Ann Arbor, MI 48103
Pearson, Bruce W., MD, 24685 Misty
Lake Dr., Ponte Vedra Beach, FL
32082-2139
Pratt, Loring W. MD, 37 Lawrence
Ave., Fairfield, ME 04937
Saunders, William H. MD, 4710 Old
Ravine Ct., Columbus, OH 43220
Toohill, Robert J., M.D., 2125 N. 91st St.,
Milwaukee, WI 53226-2603
Vaughan, Charles W., M.D., 85 Grove
St., Apt. 408, Wellesley MA 02482
Vrabec, Donald P., M.D., 2010
Snydertown Rd., Danville PA 17821
Ward, Paul H., M.D., 32178 Atosona
Dr., PO Box 250, Pauma Valley CA
92061
Williams, Russell I., M.D., 5403 Hynds
Blvd, Cheyenne WY 82009
108